Systems, methods and devices relating to implantable supportive slings

ABSTRACT

The invention provides, in various embodiments, aspects of soft tissue anchors, adjustable length/tension slings, interconnects between slings and soft tissue anchors, delivery devices and systems for implanting supportive slings, and methods relating to anchoring, adjusting and implanting supportive slings.

REFERENCE TO RELATED APPLICATIONS

This application claims priority to and the benefit of U.S. ProvisionalPatent Application Ser. No. 60/579,354, filed on Jun. 14, 2004 andentitled “Urethral Sling Device for Female Stress Urinary Incontinence,”to George Mamo, and U.S. Provisional Patent Application Ser. No.60/649,514, filed on Feb. 3, 2005 and entitled “Systems and MethodsRelating to Anchoring a Medical Implant to Tissue,” to George Mamo andMichael Weiser, the entire contents of both of which are incorporatedherein by reference.

FIELD OF THE INVENTION

The invention relates generally to implantable supportive slings. Moreparticularly, in various embodiments, the invention is directed toaspects of soft tissue anchors, adjustable length/tension slings,interconnects between slings and soft tissue anchors, delivery devicesand systems for implanting supportive slings, and methods relating toanchoring, adjusting and implanting supportive slings.

BACKGROUND OF THE INVENTION

Urinary incontinence occurs in both men and women. Various types ofincontinence are caused by different conditions and call for differenttreatments. For example, stress urinary incontinence (SUI) is known tobe caused by at least two conditions, intrinsic sphincter deficiency(ISD) and hypermobility. These conditions may occur independently or incombination. In ISD, the urinary sphincter valve, located within theurethra, fails to close properly (coapt), causing urine to leak out ofthe urethra during stressful activity. Hypermobility is a condition inwhich the pelvis floor is distended, weakened or damaged, causing thebladder neck and proximal urethra to rotate and descend in response toincreases in intra-abdominal pressure (for example, due to sneezing,coughing, straining, etc.). As a result, the patient's response timebecomes insufficient to promote urethral closure and, consequently, thepatient suffers from urine leakage and/or flow.

A popular treatment of SUI uses a surgical sling placed under thebladder neck or the mid-urethra to provide a urethral platform.Placement of the sling limits the endopelvis fascia drop. Onedisadvantage of prior art approaches is that certain mid-urethral slingstabilization procedures typically require incisions in addition tothose made in the vaginal wall. By way of example, some proceduresrequire abdominal incisions, while others require groin incisions.

Accordingly, there is a need for improved systems, devices and methodsfor treating urinary incontinence.

SUMMARY OF THE INVENTION

The invention addresses the deficiencies in the prior art by, in variousembodiments, providing improved systems, devices and methods relating tourinary incontinence. More particularly, in some embodiments, theinvention provides improved sling assemblies that make it easier for amedical operator to adjust the length and thus, the tension of the slingduring implantation. In other embodiments, the invention providesimproved soft tissue anchors for affixing supportive slings at a desiredanatomical location. I further embodiments, the invention providesdilators sized similarly to tissue anchors, which are used to deliversling ends to an anatomical location, such as into or through theobturator membrane, but subsequently dissolve, leaving only the slingend embedded in the obturator membrane to hold the sling in place. Inadditional embodiments, the invention provides improved mechanisms forattaching or otherwise associating soft tissue anchors and/or anchorsized dilators to the ends of sling assemblies to further facilitatesling length/tension adjustment. In further embodiments, the inventionprovides improved delivery devices, systems and methods for implantingsupportive slings and their associated soft tissue anchors and/or anchorsized dilators to desired anatomical sites.

According to one aspect, the invention is directed to an improvedimplantable supportive sling for treating urinary incontinence.According to one embodiment, the supportive sling of the inventionincludes a pocket formed at a first end. The pocket is sized and shapedfor receiving a distal end of a delivery device shaft. According to afurther embodiment, the supportive sling includes a second pocket formedat a second end, also sized and shaped for receiving a distal end of adelivery device shaft. In one implementation, a medical operator mayinsert a distal end of a shaft into the first end of the sling, and theninsert the distal end of the delivery device shaft and sling end intothe body of a patient, for example, via an incision in the vaginal wall,to deliver the first end of the sling to a desired anatomical location.The medical operator may deliver the second end of the sling to anotheranatomical location, for example, on a contralateral side of thepatient's body, with the same or a second delivery device using the sameor a similar approach, to implant the sling under a location to besupported, such as a mid-urethral location.

The sling may be made from any suitable material, and may includeportions having smooth or tanged edges or a combination of smooth andtanged edges. In one configuration, the sling is formed from a meshmaterial. The sling assemblies are generally short, e.g., from about 5cm to about 20 cm long. According to one construction, the sling endpockets are formed by folding over the sling material onto itself andsealing the edges. In some configurations, the entire edges of thepockets are sealed. However, in other configurations, only a portion ofone or both edges is sealed. According to one feature, portions of thesling ends are left unsealed to allow for tabs to be inserted at theentrance to each end pocket.

According to another aspect, the invention provides a plurality ofanchor sized tissue dilators, which may dissolve subsequent toimplantation. In other aspects, the invention provides a plurality ofsoft tissue anchor configurations. In some embodiments, the tissueanchors of the invention have relatively smooth outer surfaces and rely,for example, on orientation and/or features on a sling for anchoringwithin the tissue. In some such embodiments, these tissue anchors areused primarily as tissue dilators during implantation, and subsequentlydissolve, leaving just the sling ends or other tissue ingrowth sitesalong the sing to hold the sling in place.

In other embodiments, the tissue anchors of the invention include barbsprojecting from anchor bodies and are oriented for passing the anchorsinto tissue and for resisting backing the anchors out of tissue. In someembodiments, the barbs project radially from discrete locations alongthe anchor bodies. In other embodiments, the barbs are formed as ringsprojecting radially around the entire circumference of the anchors. Insome configurations, one or more of the barbs substantially alignsaxially. In other configurations, one or more of the barbs substantiallyaligns radially along a common circumference. In further configurations,the barbs are arranged so as not to align axially or radially, butinstead to be staggered in both directions. In some configurations, theanchors include only a single row of barbs substantially radiallyaligned along a circumference of the anchor. According to someembodiments, the barbs are formed by building up material onto the outerbody of an anchor. In other embodiments, the barbs are molded into theanchor. In further embodiments, the barbs are carved into the outer bodyof the anchor. In some embodiments, the barbs are formed from pealingback portions of an outer surface of the anchor.

According to some configurations, the barbs are narrow and bristle-like.In some such configurations, the bristles are relatively short (e.g.,less than about 2 millimeters in length). However, in other suchconfigurations, the barbs are longer (e.g. between about 2 millimetersand about 5 millimeters in length). According to some embodiments, thebarbs have pointed tips. However, in other configurations, the barbs mayhave rounded tips. According to some embodiments, the barbs arerelatively narrow (e.g., less than about 1 millimeter inwidth/diameter). In other embodiments, the barbs are relatively wide(e.g., between about 1 millimeter and about 2 millimeters inwidth/diameter).

According to one feature, the soft tissue anchors and/or anchor sizeddilators of the invention include an aperture sized and shaped forinterfitting over a distal tip of a delivery device shaft. In someconfigurations, the aperture extends axially from a proximal end of theanchor part way to a distal end of the anchor. In other configurations,the anchor and/or anchor sized dilator includes a through-passageextending axially between the proximal and distal ends of the anchorthus forming a hollow anchor.

According to various embodiments, the anchors and anchor sized dilatorsof the invention are generally elongated. In some configurations, theyare between about 1 centimeter and about 4 centimeters long. Accordingto one configuration, they are between about 2.5 centimeters and about3.5 centimeters long. According to other embodiments, they have anoutside diameter (not including the barbs) of between about 2millimeters and about 4 millimeters. However, in some embodiments, theyhave an outside diameter (not including the barbs) of less than about 2millimeters.

According to other embodiments, the distal tips of the anchors and/oranchor sized dilators may have any suitable configuration. In someembodiments, the distal tips are sharp enough to pierce human tissue.However, in other embodiments, the tips may be rounded. According tosome configurations, the distal ends are tapered into a conical shape toprovide for tissue dilation during sling implantation.

The anchors and/or anchor sized dilators of the invention may attach tosling ends by any suitable mechanism. In some configurations, theproximal end is, for example, glue-, heat- or shrink tube-bonded to eachend of a sling. In other configurations, a proximal portion includes aslot for interfitting with a sling end. Each sling end may be suitablybonded into a proximal slot of a respective anchor or anchor sizeddilator. In some configurations, the slot extends distally from theproximal end of the anchor or anchor sized dilator along across-sectional diameter of the anchor or anchor sized dilator.According to various constructions, the slings to which the anchors oranchor sized dilators attach are between about 5 centimeters and about 8centimeters long. In one embodiment, they are about 6 centimeters long.According to a further construction, the total (i.e., anchor/dilator tipto opposite anchor/dilator tip) sling assembly length is between about 8centimeters and about 14 centimeters. In one embodiment, the total slingassembly length is about 12 centimeters.

According to some aspects, the tissue anchors/dilators of the inventionare configured for attaching to a sling end in a sling length/tensionadjustable manner. For example, in one embodiment, an anchor/dilatorincludes a radial aperture in a side wall near its proximal end. A firstend of a filament threads through the aperture and a second end of thefilament threads through an aperture in a sling end. The aperture in thesling may be, for example, a gap in a mesh or may be separately formed,and optionally reinforced. The length of the filament, and thus theoverall length of the sling assembly (i.e., from anchor/dilator distaltip to opposite anchor/dilator distal tip), may be adjusted by pullingon the filament terminal ends and securing them. In some configurations,the filament terminal ends may be secured together, for example, byclipping, tying, gluing or other suitable mechanism. By way of example,in one configuration, the filament ends are tied together in a one-wayslip knot, which easily slides to be tightened, but not to be loosened.

According to one embodiment, the filament threads through the apertureor other suitable structure in the anchor/dilator. Then, each end of thefilament threads through a separate aperture in the sling end. Thefurther the filament ends are drawn through the sling end apertures, thecloser to the sling end the anchor is drawn, once again adjusting theoverall length of the sling assembly. As in the prior example, thefilament ends may be secured together to hold the sling assembly lengthconstant. The filament ends may be secured, for example, by tying, tyingin a one-way slip knot, glued, clipped, or passed through a one-wayadjustable holder.

In a further embodiment, the anchor/dilator attaches to a sling end, andthe filament ends thread through respective apertures in the sling end.Then, each of the filament ends interweaves with the sling materialalong at least a partial length of the sling. In one configuration, onefilament end interweaves with the sling material along one long edge ofthe sling, and the other filament end interweaves with the slingmaterial along the other long edge of the sling material. In response topulling on the terminal ends of the filament, the sling materialaccordions to reduce its effective length. In some configurations, theinterwoven filament is employed only at one end of a sling assembly,with the other end remaining at a fixed location. In some suchembodiments, the filament-interwoven, and thus accordionable slingsection extends for substantially the entire length of the sling. Inother embodiments, the filament is interwoven with half or less of thelength of the sling. In further embodiments, the sling assembly employssuch interwoven filaments at both ends. In some constructions, theinterwoven filaments pass first through an aperture or other suitablestructure on an anchor, for example, to attach the anchor/dilator to thesling.

According to alternative embodiments, a tissue anchor/dilator of theinvention includes a loop, for example, extending from a proximal end. Asling end may slidably interfit within the loop and the anchor/dilatormay be placed at any desired location along the length of the sling.Once placed, the anchor/dilator may be secured in position. Theanchor/dilator may be secured in place, for example, with a vascular orany other suitable clip, a suture, or a staple. In the case of the clipor staple, they may be placed on a sling-end side of the anchor to stopthe anchor/dilator from sliding in a lengthening direction or slidingoff the sling altogether. In some configurations, the loop may includeangled spikes or teeth that are oriented to enable the loop, and thusthe anchor/dilator, to slide onto the sling, but not allow it to slidein an opposite (e.g., lengthening) direction. In other configurations, aportion of the sling may include one-way bristles or spikes that areoriented to enable the sling end to be inserted into the anchor/dilatorloop, but inhibit sliding the anchor/dilator back off the sling in asling-lengthening direction. In a variation of this configuration, thesling assembly includes an elongated, anchor-like element attached tothe sling end. This element includes the directionally oriented spikes,bristles or other projections positioned to slide into theanchor/dilator loop and to impede sliding out of the anchor/dilatorloop. The anchor/dilator may be slid along the length of thisanchor-like attachment to adjust the overall (anchor/dilator distal tipto anchor/dilator distal tip) length of the sling assembly.

In other configurations, the sling assembly may include a one waybuckle, such as that employed on backpacks, for passing the sling endthrough and adjusting the sling length/tension. In some configurations,the buckle may be, or may be attached to, the anchor/dilator loop.Alternatively, the buckle may be formed into the body of theanchor/dilator. In other configurations, the buckle is located on thesling end, independent from the sling end passing through a loop orother suitable structure on the anchor/dilator. In furtherconfigurations, the one way buckle may be placed at any suitablelocation along the length of the sling.

In another embodiment, an anchor/dilator of the invention includes ahollow portion extending axially from a proximal end at least part wayto a distal end of the anchor/dilator, and a bar or other structureextending radially across the hollow portion inside the anchor/dilator.In this embodiment, a sling end may pass into the hollow portion via aproximal opening in the anchor/dilator, then loop around the bar andback out of the proximal end of the anchor/dilator. In someconfigurations, the bar may include spikes, bristles or otherprojections for allowing the sling end to pass through the hollowportion in a sling shortening direction, but impeding the sling frompassing in an opposite sling-lengthening direction. In otherconfigurations, the sling end may be secured, for example, by way of aclip, staple or suture, outside the anchor/dilator subsequent to theanchor/dilator being placed at a desired location along the slinglength. As in all of the described embodiments, excess sling-endmaterial may be trimmed off.

In some embodiments, sling assemblies of the inventions are formed intwo sections. In various configurations, one end of each sectionincludes a tissue anchor/dilator and the other end of each section maybe affixed together to achieve a desired sling assembly length. In oneimplementation, one or both of the non-anchor/dilator ends of the twosling assembly sections are cut to length and then attached, forexample, by way of suturing, tying, clipping, stapling or heatmelting/bonding. In another implementation, the anchor/dilator end ofone of the sections is passed through an aperture near thenon-anchor/dilator end of the other section. The anchor/dilator ispulled through to a desired length and is then secured in place near theaperture. In some configurations, the sling assembly section beingpassed through the aperture includes projections for resisting thatsection from being pulled back out of the aperture in the oppositedirection.

According to another aspect, the invention is directed to stackabletissue anchors/dilators. In one embodiment, a first tissueanchor/dilator attaches to a sling end. Then, a second tissueanchor/dilator may slidably interfit over a distal end of the firstanchor/dilator to effectively create a longer anchor/dilator with a newdistal end. By stacking anchors/dilators in this fashion, the overall(anchor/dilator distal tip to anchor/dilator distal tip) length of thesling assembly may be increased. Previously stacked anchors/dilators maybe unstacked to reduce the length of the sling assembly. According toone feature, each anchor/dilator one or more radially extendingapertures in its side wall near a proximal end, and one or morecorresponding radial projections in its side wall near a distal end. Thedistal radial projections of the first anchor/dilator snap fit into theproximal radial apertures of the second anchor/dilator to hold the twoanchors/dilators together when stacked. Any number of anchors/dilatorsmay be stacked in this fashion.

In other aspects, the invention provides devices and/or systems fordelivering a sling assembly to anatomical locations within the body of apatient. Delivery systems include, for example, a sling assembly havingat least one tissue anchor/dilator, along with a suitable deliverydevice. According to one embodiment, a delivery device of the inventionincludes a handle and a shaft extending distally from a distal end ofthe handle. A distal end of the shaft may, for example, be sharp enoughfor piercing tissue, conical in shape for tunneling, or rounded blunt.The shaft may have one or more substantially straight sections and/orone or more curved sections. The shaft may be formed substantially in asingle plane, substantially in two planes, or in more than two planes.In one configuration, the delivery device is sized and shaped fordelivering sling ends (and tissue anchors/dilators) transvaginally to asuprapubic location (e.g. on the posterior/bladder side of the pubicbone). In other configurations, the delivery device is sized and shapedfor delivering the sling ends (and tissue anchors/dilators)transvaginally to a prepubic location (e.g. a location between the pubicbone and the abdominal wall on the anterior side of the pubic bone).This approach has the advantage that there is considerably less risk ofinadvertently puncturing the bladder during placement. In furtherconfigurations, the delivery device is sized and shaped for deliveringthe sling ends (and tissue anchors/dilators) transvaginally near, intoor through the obturator membrane. In a variation of this configuration,the delivery devices may be sized and shaped for initiating thisprocedure by inserting a distal end of the delivery device into thepatient's body via a vaginal wall incision, or alternatively, via aninner thigh incision.

According to one embodiment, a delivery device of the invention includesa narrowed distal end configured for interfitting with an aperture, ahollow through passage or other suitable feature on a tissueanchor/dilator. Optionally, a shoulder is formed near the distal end ofthe shaft. When inserted into the anchor/dilator, the shoulder of thedelivery device shaft abuts the proximal end of the anchor/dilator. Invarious configurations, the narrowed distal portion is between about 2centimeters and about 4 centimeters long. In other configurations it isbetween about 1 centimeter and about 3centimeters long. In furtherconfigurations, the narrowed distal portion has an outside diameter ofbetween about 0.03 inch and about 0.05 inch. In one embodiment, it hasan outside diameter of about 0.04 inches. According to otherconfigurations, the portion of the shaft forming the shoulder has anoutside diameter of between about 0.07 inch and about 0.1 inch. In oneimplementation the outside diameter of this portion of the shaft isabout 0.09 inch. According to one configuration, the total shaft lengthis between about 7 centimeters and about 20 centimeters. In otherconfigurations, the total length of the shaft is between about 8centimeters and about 12 centimeters.

According to a further embodiment, the delivery device includes an innershaft and an outer cannula. In one configuration, a distal end of theouter cannula forms a radially extending shoulder around the innershaft. Additionally, the narrow inner shaft extends distally from theouter cannula (similar to the above described narrowed distal shaftportion) with the outer cannula in a retracted position. According tosome embodiments, the delivery device includes a pusher near a distalend of the handle for sliding the outer cannula axially over the innershaft. In operation, with the pusher retracted, an anchor/dilator isinterfitted over the narrowed distal portion of the shaft. Subsequent toanchor/dilator placement, the medical operator slides the pusherdistally to push the anchor/dilator off of the narrowed distal portion,and withdraws the delivery device from the patient.

In an alternative embodiment, outer cannula remains fixed and the innershaft is slidable. More particularly, the delivery device of theinvention includes a slidable shaft actuator located on the handle, forenabling an operator to alternatingly extend and retract the distalportion of the shaft from the distal end of the cannula. In operation ofthis embodiment, an operator extends the distal portion of the shaft toinsert it into the tissue anchor/dilator. Subsequent to anchor/dilatorplacement, the operator retracts the distal portion of the shaft todisengage it from the anchor/dilator, and withdraws the delivery devicefrom the patient.

According to another embodiment, a delivery device of the inventionincludes a dilator, a pusher and a guide member. In operation a dilatoris inserted through an incision in the vaginal wall until its distal tipreaches a location at or near to where an anchor/dilator is to beimplanted. The guide member, optionally a guide wire, is insertedaxially through the dilator until it extends out of the distal tip ofthe dilator. The dilator is then slid proximally along the guide wire toremove the dilator from the patient's body. A hollow anchor/dilator of asling assembly is then slid over a proximal end of the guide wire andslid distally along the guide wire. A pusher is then slid over theproximal end of the guide wire and also slid distally along the guidewire to advance the tissue anchor/dilator along the wire until itreaches a desired location within the body of the patient. The pusherand the guide wire are then removed to leave the tissue anchor/dilatorin place.

In another embodiment, a delivery device of the invention includes ahollow insertion shaft and a push wire. In this embodiment, a tissueanchor/dilator of a sling assembly interfits over a distal end of theinsertion shaft. The distal end of the shaft with the anchor/dilator sointerfitted is inserted into the body of the patient via a vaginalincision. The shaft is advanced distally until the anchor/dilator islocated at the desired site of implantation. The push wire is theninserted into a proximal end of the shaft and advanced distally until adistal end of the push wire abuts the tissue anchor/dilator. The pushwire is then further advanced distally to push the anchor/dilator off ofthe insertion shaft to implant the anchor/dilator at the desiredlocation. The insertion shaft and the push wire are then removed fromthe patient.

As mentioned above, according to some embodiments, the methods of theinvention deliver a tissue anchor/dilator of a sling assembly to theobturator foramen. In one approach, the anchor/dilator is delivered to alocation in front of the obturator membrane. In another approach, theanchor/dilator is delivered into the obturator membrane. Theanchor/dilator may also be fixed to the obturator membrane. In a furtherapproach, the anchor/dilator is delivered through the obturatormembrane. In some practices, the anchor/dilator is delivered through theobturator membrane to about 2.5 centimeters into the obturator foramen.In other practices, the anchor/dilator is delivered through theobturator membrane about 1 centimeter to about 2.5 centimeters into theobturator formen.

These and other features, embodiments and aspects of the invention willbe further understood with reference to the description of theillustrative embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

Illustrative embodiments of the invention are described below withreference to the appended drawings, in which like parts have likereference designations and in which the various depicted parts may notbe drawn to scale. The depicted embodiments are to be understood asillustrative of the invention and not as limiting in any way.

FIGS. 1A-1B depict different views of a mesh sling including end pocketsaccording to an illustrative embodiment of the invention.

FIGS. 2A-2E each depict various soft tissue anchors/dilators accordingto illustrative embodiments of the invention.

FIGS. 3A-3B depict an approach for affixing a sling end to a soft tissueanchor/dilator according to an alternative illustrative embodiment ofthe invention.

FIGS. 4A-4B depict an approach for affixing a sling end to a soft tissueanchor/dilator according to another alternative illustrative embodimentof the invention.

FIGS. 5A-5G depict various hollow soft tissue anchors/dilators accordingto illustrative embodiments of the invention.

FIGS. 6A-6D depict approaches for affixing a soft tissue anchor/dilatorto a sling end in such a way as to provide for sling assemblylength/tension adjustment according to various illustrative embodimentsof the invention.

FIGS. 7A-7C depict approaches for length/tension adjusting animplantable sling assembly using filaments, for example, tied in one wayknots and/or interwoven with the sling material according toillustrative embodiments of the invention.

FIGS. 8A-8B are perspective and side views, respectively, of a slingassembly end including a soft tissue anchor/dilator with an internal barabout which sling length/tension may be adjusted according to anillustrative embodiment of the invention.

FIGS. 9A-9B show a soft tissue anchor/dilator having a loop forreceiving a ridged/jagged element attached to an end of a sling forproviding sling length/tension adjustment according to anotherillustrative embodiment of the invention.

FIG. 10 shows a sling assembly including two sections attached togetherat an intermediate location to provide for adjustable sling/tensionaccording to another illustrative embodiment of the invention.

FIG. 11 shows another two section sling assembly adapted for adjustablyinterfitting at an intermediate location to provide for adjustable slinglength/tension according to a further illustrative embodiment of theinvention.

FIGS. 12A-12B show adjustable length/tension sling assemblies having anend clip for affixing a sling end to a soft tissue anchor/dilator at adesired sling length according to another illustrative embodiment of theinvention.

FIGS. 13A-13B depict soft tissue anchor/dilator having a buckle in aside wall for interthreading with a sling end to provide for adjustablesling length/tension according to an additional embodiment of theinvention.

FIGS. 14A-14B depict an arrangement of interlocking stackable softtissue anchors/dilators for providing adjustable sling assemblylength/tension according to another embodiment of the invention.

FIGS. 15A-15B show a delivery device including a shaft having a narroweddistal tip for interfitting with a soft tissue anchor/dilator of a slingassembly according to an illustrative embodiment of the invention.

FIG. 16 shows a delivery device having a slidable inner shaft forengaging with a soft tissue anchor/dilator of a sling assembly accordingto an illustrative embodiment of the invention.

FIG. 17 shows a delivery device having a slidable outer cannula and anarrowed inner shaft for engaging with a soft tissue anchor/dilator of asling assembly according to an illustrative embodiment of the invention.

FIG. 18 shows a delivery system for implanting a sling assemblyincluding a hollow soft tissue anchor/dilator to an anatomical siteaccording to an illustrative embodiment of the invention.

FIGS. 19A-19B show a delivery system for implanting a sling assemblyincluding a soft tissue anchor/dilator to an anatomical site accordingto another illustrative embodiment of the invention.

FIG. 20 shows a delivery system employing a delivery device having aspiral shaft according to an illustrative embodiment of the invention.

FIG. 21 shows a delivery device having a curved shaft for delivering asling assembly, for example, transobturally according to an illustrativeembodiment of the invention.

FIGS. 22A-22C show various views of a delivery device having a haloshaft for delivering a sling assembly, for example, transobturallyaccording to another illustrative embodiment of the invention.

FIGS. 23A-23C depict an approach for delivering a sling assemblytransobturally using the delivery system of FIG. 18 according to anillustrative embodiment of the invention.

FIGS. 24A-24C depict an approach for delivering a sling assemblytransobturally using the delivery system of FIGS. 22A-22C according toan illustrative embodiment of the invention.

FIGS. 25A-25C show a detailed view of placing a soft tissueanchor/dilator of a sling assembly according to an illustrativeembodiment of the invention.

FIGS. 26A-26B show a detailed view of an alternative placement of a softtissue anchor/dilator of a sling assembly according to anotherillustrative embodiment of the invention.

ILLUSTRATIVE DESCRIPTION

As described above in summary, the invention addresses deficiencies inthe prior art by, in various illustrative embodiments, providingimproved systems, methods and devices related to implanting supportiveslings within the human body. In particular illustrative embodiments,the systems, methods and devices of the invention are particularlysized, shaped and adapted for delivering a sling to periurethral tissueto provide urethral, bladder, and/or bladder neck support for treatingurinary incontinence. As described below in further detail, some of theillustrative embodiments are directed to improved sling and slingassemblies. Other illustrative embodiments are directed to improvedtissue anchors, such as soft tissue anchors, for anchoring one or bothends of a sling or sling assembly at a desired anatomical location.Further illustrative embodiments, are directed to anchor sized dilators,which in various implementations may be sized and shaped like any of thedescribed anchors, except with substantially smooth outer surfaces. Insome of these illustrative embodiments, the dilator/anchor relies ondilator/anchor orientation, rather than barbs for anchoring. In otherillustrative embodiments, the anchor/dilator dissolves and isbioabsorbed, leaving only the sling ends or other locations along thesling itself to hold the sling in place. In some illustrativeembodiments, the improved anchors/dilators include, for example,improved anchoring structures, improved interfittings with deliverydevices, improved features for attaching the anchors to the slingassembly in a length/tension adjustable manner, and the like. Additionalillustrative embodiments are directed to improved delivery devices andsling delivery systems. The illustrative delivery systems include, forexample, a sling assembly along with a delivery device. Otherillustrative embodiments describe exemplary procedures for implanting asupportive sling employing features of the invention.

Turning to the depicted illustrative embodiments, FIGS. 1A and 1B depicttop and side views, respectively, of a sling 100 including end pockets102 and 104. The end pockets 102 and 104 are formed by folding a shortlength of an end of the sling, e.g., about 0.5 inches to about 1.0inches, over onto itself and closing the edges. For example, the edges106 a and 106 b are closed to form the pocket 102 and the edges 108 aand 108 b are closed to form the pocket 104. The edges may be closed,for example, by way of suturing, gluing or heat sealing. The edgeclosures may extend for the entire length of the folded over portions,or as most clearly shown in FIG. 1B, a portion 109 and 110 of therespective folder over portions may be left without its edges closed toprovide for free tabs at the entrance to the pockets 102 and 104.

In certain illustrative embodiments, the pockets 102 and 104 of thesling 100 may be coated or otherwise treated with a material to stiffenand/or strengthen them. According to the illustrative embodiment, thesling 100 is between about 5 centimeters and about 20 centimeters long.According to a feature of the sling 100, a distal end of a deliverydevice shaft may be inserted into either pocket 102 or 104 and theninserted through a vaginal incision to deliver a sling end to ananatomical site. With the delivery device removed, either or both of thepockets 102 and 104 may employed as a soft tissue anchor. By way ofexample, the pocket 102 and/or 104 may be implanted into or through aobturator membrane or other tissue, muscle, ligament or suitableanatomical structure. The folded over sling material then resists thepulling of the end pocket back out of the membrane or other structure toanchor the sling end in place.

The sling 100 may be formed from any suitable materials andconfigurations. For example, the sling 100 may be formed from anomnidirectional material, a material that has equivalent tensilestrength from any direction, such as pericardium or dermis.Alternatively, the material may be an oriented material, a material thathas a single direction where the tensile strength of the material is thehighest. Oriented materials may include rectus fascia and/or facia lata.

The edge or other regions of the sling 100 can be configured differentlydepending on their intended placement in the body of the patient. Forexample, a middle section of the sling 100 is typically located where ananatomical site, such as a midurethral or bladder neck location in theperiurethral tissue, needs to be supported. In one illustrativeembodiment, a middle section of the sling 100 has smooth or roundededges, hereinafter also referred to as “non-tanged.” According to afurther illustrative embodiment, other sections of the sling 100 mayinclude tangs (e.g., sharp projections or frayed edges). The tangs aregenerally useful for anchoring the sling 100 and encouraging tissuegrowth into the sling 100. Anchoring the sling 100 in this mannergenerally obviates the need for additional sutures to hold the sling 100in place. Anchoring the sling 100 via its tangs is especially useful foranchoring the sling 100 on a tissue and facilitating the removal of thesleeve according to the invention by pulling on the center tab of thesleeve while the sling 100 stays in place, without the need foradditional incisions in order to hold the sling 100 external to the bodywhile the sleeve is being removed through pulling.

The tanged and non-tanged edges of the sling 100 may be formed in aplurality of ways. For example, the sling 100 can be cut from a wovensheet, in which case the edges would be initially tanged along theentire length of the sling 100. One or more non-tanged sections may beformed by any process that smoothes, rounds or removes the sharp edgesof the tangs. For example, the tangs may be heat-smoothed by burning ormelting the tangs. Providing one or more non-tanged sections, which maybe in close proximity to a sensitive anatomical site in the patient, canenhance the comfort level of the patient and reduce the potential forthe edges of the tangs to erode or irritate the urethra. Alternatively,the sling 100 can be produced from a woven tape having the approximatefinished width of the sling 100. The smooth sides of the tape can thenbe trimmed off to produce the tanged sections.

The sling 100 used with the invention may be fabricated from anysuitable material(s), preferably biocompatible materials. In certainillustrative embodiments, the material may include, for example,synthetic mesh or other synthetic material; it may also or alternativelyinclude non-synthetic material, such as cadaver, human or animal tissue;it may also include any combinations thereof. In examples employingsynthetic material for the sling 100, it may be derived from anysuitable synthetic material. Such material could include, for example,polymeric material such as, for example, as Polytetrafluorethylene(Goretex), polypropylene (Marlex), polyethylene (Mersiline), silastic,or impregnated collagen matrix (Protegen). In certain illustrativeembodiments, one or more suitable materials for the sling 100 mayinclude, for example, nylon, polyethylene, polyester, polypropylene,fluoropolymers, copolymers thereof, combinations thereof, or othersuitable synthetic material(s). The material may be, for example, asynthetic material that is absorbable by the patient's body. Suitableabsorbable synthetic materials can include polyglycolic acid, polylacticacid, and other suitable absorbable synthetic materials. The sling 100material may be fabricated from one or more yarns, which yarns may bemade from one or more materials.

Alternatively, the materials for the sling 100 may employ non-syntheticor natural materials, for example materials from human fascia, cadavericfascia or skin mammalian tissue(s). Human tissues may be used in certainembodiments and may be derived, for example, from human cadaveric orengineered human tissue. Animal tissues may be derived, for example,from porcine, ovine, bovine, and equine tissue sources. In certainembodiments the materials for the sling 100 may include a combination ofnon-synthetic (e.g., mammalian tissue(s)) and synthetic material(s).

According to a further illustrative embodiment, any or all of the sling100 may be configured to be biodegradable/bioabsorbable. According toanother feature, at least a portion of the sling 100 is biodegradableand may also dissolve and/or be absorbed into the patient's tissues. Forexample, in some embodiments, only a section of the sling 100 isbiodegradable/bioabsorbable, such as, for example, an intermediateportion. Examples of biodegradable/bioabsorbable materials that may beused for the sling 100 include, without limitation, polylactic acid(PLA), polyglycolic acid (PGA), poly-L-lactic acid (PLLA), human dermisand decellularized animal tissue.

Exemplary biodegradable/bioabsorbable materials, in addition to thoselisted above, which may be employed for the sling 100 include, but arenot limited to, polylactic acid, polyglycolic acid and copolymers andmixtures thereof, such as poly(L-lactide) (PLLA), poly(D,L-lactide)(PLA), polyglycolic acid [polyglycolide (PGA)],poly(L-lactide-co-D,L-lactide) (PLLA/PLA), poly(L-lactide-co-glycolide)(PLLA/PGA), poly(D,L-lactide-co-glycolide) (PLA/PGA),poly(glycolide-co-trimethylene carbonate) (PGA/PTMC),poly(D,L-lactide-co-caprolactone) (PLA/PCL), andpoly(glycolide-co-caprolactone) (PGA/PCL); polyethylene oxide (PEO);polydioxanone (PDS); polypropylene fumarate; polydepsipeptides,poly(ethyl glutamate-co-glutamic acid),poly(tert-butyloxy-carbonylmethyl glutamate); polycaprolactone (PCL),poly(hydroxy butyrate), polycaprolactone co-butylacrylate,polyhydroxybutyrate (PHBT) and copolymers of polyhydroxybutyrate;polyphosphazenes, poly(phosphate ester); maleic anhydride copolymers,polyiminocarbonates, poly[(97.5% dimethyl-trimethylenecarbonate)-co-(2.5% trimethylene carbonate)], cyanoacrylate,hydroxypropylmethylcellulose; polysaccharides, such as hyaluronic acid,chitosan and regenerate cellulose; poly(amino acid) and proteins, suchas gelatin and collagen; and mixtures and copolymers thereof.

According to a further illustrative embodiment, the sling 100 mayincorporate or be coated with one or more agents to provide atherapeutic effect, for example, to reduce discomfort, to reduce thechance of infection and/or to promote tissue growth. The sling 100 maybe treated or coated with any suitable material. For example, in someillustrative embodiments, suitable treatment materials may includebioabsorbable/dissolvable materials which may include, but are notlimited to, alginates, sugar based formulations, starches, gelatins,cellulose, polyvinyl alcohol, polyglycolic acid (PGA), polylactic acid(PLA), polydioxinone (PDO), and/or other synthetic or natural polymersincluding combinations thereof. The treatment materials are preferablybiocompatible, and the biocompatible protective treatment may cover anyportion or all of the sling 100. In one particular configuration, theprotective treatment encapsulates or substantially encapsulates at leastportion of the sling 100. According to one feature, the protectivetreatment is formed from lubricious material and reduces the frictionbetween the sling 100 and the patient's periurethral tissues. In thisway, the protective treatment can provide a relatively smooth tissuecontact surface to otherwise tanged or ragged sling edges to reduce thelikelihood of the sling 100 irritating the patient's tissues duringimplantation.

The protective treatment may be applied to the sling 100 by any suitableapproach, for example, by way of spraying, brushing or dipping theportion of the sling 100 to be treated. According to anotherillustrative embodiment, the protective treatment is formed as a sheetof material that can be affixed to the portion of the sling 100 to betreated. According to another feature, the protective treatment may beconfigured to dissolve within a particular time range. The protectivetreatment may be configured, for example, to substantially absorb intothe patient's tissues within about 30, 15, 10 or 5 minutes from the timethe sling 100 is implanted. Alternatively, the protective treatment maybe configured to substantially absorb into the patient's tissues over atime span of hours, days, weeks, or months.

According to another illustrative feature, the sling 100 may alsoinclude an agent for release into the patient's tissues. Oneillustrative agent promotes, when applied to the patient's tissues in apharmaceutically acceptable amount, well-organized collagenous tissuegrowth, such as scar tissue growth, preferably, in large quantities.According to one feature, the agent may or may not block or delay thedissolvability of the protective treatment. This may be controlled byselecting differing methods for loading the agent onto the sling 100.The tissue growth factor may include natural and/or recombinant proteinsfor stimulating a tissue response so that collagenous tissue such asscar tissue growth is enhanced. Exemplary growth factors that may beused include, but are not limited to, platelet-derived growth factor(PDGF), fibroblast growth factor (FGF), transforming growth factor-beta(TGF-beta), vascular endothelium growth factor (VEGF), activin/TGF andsex steroid, bone marrow growth factor, growth hormone, insulin-likegrowth factor 1, and combinations thereof. The agent may also include ahormone, including but not limited to estrogen, steroid hormones, andother hormones to promote growth of appropriate collagenous tissue suchas scar tissue. The agent may also include stem cells or other suitablecells derived from the host patient. These cells may be fibroblast,myoblast, or other progenitor cells to mature into appropriate tissues.

In various illustrative embodiments, the agent may include one or moretherapeutic agents. The therapeutic agents may be, for example,anti-inflammatory agents, including steroidal and non-steroidalanti-inflammatory agents, analgesic agents, including narcotic andnon-narcotic analgesics, local anesthetic agents, antispasmodic agents,growth factors, gene-based therapeutic agents, and combinations thereof.

Exemplary steroidal anti-inflammatory therapeutic agents(glucocorticoids) include, but are not limited to,21-acetoxyprefnenolone, alclometasone, algestone, amicinonide,beclomethasone, betamethasone, budesonide, chloroprednisone, clobetasol,clobetasone, clocortolone, cloprednol, corticosterone, cortisone,cortivazol, deflazacort, desonide, desoximetasone, dexamethasone,diflorasone, diflucortolone, difluprednate, enoxolone, fluazacort,flucloronide, flumehtasone, flunisolide, fluocinolone acetonide,fluocinonide, fluocortin butyl, fluocortolone, fluorometholone,fluperolone acetate, fluprednidene acetate, fluprednisolone,flurandrenolide, fluticasone propionate, formocortal, halcinonide,halobetasol priopionate, halometasone, halopredone acetate,hydrocortamate, hydrocortisone, loteprednol etabonate, mazipredone,medrysone, meprednisone, methyolprednisolone, mometasone furoate,paramethasone, prednicarbate, prednisolone, prednisolone25-diethylaminoacetate, prednisone sodium phosphate, prednisone,prednival, prednylidene, rimexolone, tixocortal, triamcinolone,triamcinolone acetonide, triamcinolone benetonide, triamcinolonehexacetonide, and pharmaceutically acceptable salts thereof.

Exemplary non-steroidal anti-inflammatory therapeutic agents include,but are not limited to, aminoarylcarboxylic acid derivatives such asenfenamic acid, etofenamate, flufenamic acid, isonixin, meclofenamicacid, mefanamic acid, niflumic acid, talniflumate, terofenamate andtolfenamic acid; arylacetic acid derivatives such as acemetacin,alclofenac, amfenac, bufexamac, cinmetacin, clopirac, diclofenac sodium,etodolac, felbinac, fenclofenac, fenclorac, fenclozic acid, fentiazac,glucametacin, ibufenac, indomethacin, isofezolac, isoxepac, lonazolac,metiazinic acid, oxametacine, proglumetacin, sulindac, tiaramide,tolmetin and zomepirac; arylbutyric acid derivatives such as bumadizon,butibufen, fenbufen and xenbucin; arylcarboxylic acids such as clidanac,ketorolac and tinoridine; arylpropionic acid derivatives such asalminoprofen, benoxaprofen, bucloxic acid; carprofen, fenoprofen,flunoxaprofen, flurbiprofen, ibuprofen, ibuproxam, indoprofen,ketoprofen, loxoprofen, miroprofen, naproxen, oxaprozin, piketoprofen,pirprofen, pranoprofen, protizinic acid, suprofen and tiaprofenic acid;pyrazoles such as difenamizole and epirizole; pyrazolones such asapazone, benzpiperylon, feprazone, mofebutazone, morazone,oxyphenbutazone, phenybutazone, pipebuzone, propyphenazone,ramifenazone, suxibuzone and thiazolinobutazone; salicylic acidderivatives such as acetaminosalol, aspirin, benorylate, bromosaligenin,calcium acetylsalicylate, diflunisal, etersalate, fendosal, gentisicacid, glycol salicylate, imidazole salicylate, lysine acetylsalicylate,mesalamine, morpholine salicylate, 1-naphthyl salicylate, olsalazine,parsalmide, phenyl acetylsalicylate, phenyl salicylate, salacetamide,salicylamine o-acetic acid, salicylsulfuric acid, salsalate andsulfasalazine; thiazinecarboxamides such as droxicam, isoxicam,piroxicam and tenoxicam; others such as ε-acetamidocaproic acid,s-adenosylmethionine, 3-amino-4-hydroxybutyric acid, amixetrine,bendazac, benzydamine, bucolome, difenpiramide, ditazol, emorfazone,guaiazulene, nabumetone, nimesulide, orgotein, oxaceprol, paranyline,perisoxal, pifoxime, proquazone, proxazole and tenidap; andpharmaceutically acceptable salts thereof.

Exemplary narcotic analgesic therapeutic agents include, but are notlimited to, alfentanil, allylprodine, alphaprodine, anileridine,benzylmorphine, bezitramide, buprenorphine, butorphanol, clonitazene,codeine, codeine methyl bromide, codeine phosphate, codeine sulfate,desomorphine, dextromoramide, dezocine, diampromide, dihydrocodeine,dihydrocodeinone enol acetate, dihydromorphine, dimenoxadol,dimepheptanol, dimethylthiambutene, dioxaphetyl butyrate, dipipanone,eptazocine, ethoheptazine, ethylmethylthiambutene, ethylmorphine,etonitazene, fentanyl, hydrocodone, hydromorphone, hydroxypethidine,isomethadone, ketobemidone, levorphanol, lofentanil, meperidine,meptazinol, metazocine, methadone hydrochloride, metopon, morphine,myrophine, nalbuphine, narceine, nicomorphine, norlevorphanol,normethadone, normorphine, norpipanone, opium, oxycodone, oxymorphone,papaveretum, pentazocine, phenadoxone, phenazocine, pheoperidine,piminodine, piritramide, proheptazine, promedol, properidine, propiram,propoxyphene, rumifentanil, sufentanil, tilidine, and pharmaceuticallyacceptable salts thereof.

Exemplary non-narcotic analgesic agents that may be combined with thesling 100 include, but are not limited to, aceclofenac, acetaminophen,acetaminosalol, acetanilide, acetylsalicylsalicylic acid, alclofenac,alminoprofen, aloxiprin, aluminum bis(acetylsalicylate),aminochlorthenoxazin, 2-amino-4-picoline, aminopropylon, aminopyrine,ammonium salicylate, amtolmetin guacil, antipyrine, antipyrinesalicylate, antrafenine, apazone, aspirin, benorylate, benoxaprofen,benzpiperylon, benzydamine, bermoprofen, brofenac, p-bromoacetanilide,5-bromosalicylic acid acetate, bucetin, bufexamac, bumadizon, butacetin,calcium acetylsalicylate, carbamazepine, carbiphene, carsalam,chloralantipyrine, chlorthenoxazin(e), choline salicylate, cinchophen,ciramadol, clometacin, cropropamide, crotethamide, dexoxadrol,difenamizole, diflunisal, dihydroxyaluminum acetylsalicylate,dipyrocetyl, dipyrone, emorfazone, enfenamic acid, epirizole,etersalate, ethenzamide, ethoxazene, etodolac, felbinac, fenoprofen,floctafenine, flufenamic acid, fluoresone, flupirtine, fluproquazone,flurbiprofen, fosfosal, gentisic acid, glafenine, ibufenac, imidazolesalicylate, indomethacin, indoprofen, isofezolac, isoladol, isonixin,ketoprofen, ketorolac, p-lactophenetide, lefetamine, loxoprofen, lysineacetylsalicylate, magnesium acetylsalicylate, methotrimeprazine,metofoline, miroprofen, morazone, morpholine salicylate, naproxen,nefopam, nifenazone, 5′ nitro-2′ propoxyacetanilide, parsalmide,perisoxal, phenacetin, phenazopyridine hydrochloride, phenocoll,phenopyrazone, phenyl acetylsalicylate, phenyl salicylate, phenyramidol,pipebuzone, piperylone, prodilidine, propacetamol, propyphenazone,proxazole, quinine salicylate, ramifenazone, rimazolium metilsulfate,salacetamide, salicin, salicylamide, salicylamide o-acetic acid,salicylsulfuric acid, salsalte, salverine, simetride, sodium salicylate,sulfamipyrine, suprofen, talniflumate, tenoxicam, terofenamate,tetradrine, tinoridine, tolfenamic acid, tolpronine, tramadol, viminol,xenbucin, zomepirac, and pharmaceutically acceptable salts thereof.

Exemplary local anesthetic therapeutic agents include, but are notlimited to, ambucaine, amolanone, amylocaine hydrochloride, benoxinate,benzocaine, betoxycaine, biphenamine, bupivacaine, butacaine, butaben,butanilicaine, butethamine, butoxycaine, carticaine, chloroprocainehydrochloride, cocaethylene, cocaine, cyclomethycaine, dibucainehydrochloride, dimethisoquin, dimethocaine, diperadon hydrochloride,dyclonine, ecgonidine, ecgonine, ethyl chloride, beta-eucaine, euprocin,fenalcomine, fomocaine, hexylcaine hydrochloride, hydroxytetracaine,isobutyl p-aminobenzoate, leucinocaine mesylate, levoxadrol, lidocaine,mepivacaine, meprylcaine, metabutoxycaine, methyl chloride, myrtecaine,naepaine, octacaine, orthocaine, oxethazaine, parethoxycaine, phenacainehydrochloride, phenol, piperocaine, piridocaine, polidocanol, pramoxine,prilocaine, procaine, propanocaine, proparacaine, propipocaine,propoxycaine hydrochloride, pseudococaine, pyrrocaine, ropavacaine,salicyl alcohol, tetracaine hydrochloride, tolycaine, trimecaine,zolamine, and pharmaceutically acceptable salts thereof.

Exemplary antispasmodic therapeutic agents include, but are not limitedto, alibendol, ambucetamide, aminopromazine, apoatropine, bevoniummethyl sulfate, bietamiverine, butaverine, butropium bromide,n-butylscopolammonium bromide, caroverine, cimetropium bromide,cinnamedrine, clebopride, coniine hydrobromide, coniine hydrochloride,cyclonium iodide, difemerine, diisopromine, dioxaphetyl butyrate,diponium bromide, drofenine, emepronium bromide, ethaverine, feclemine,fenalamide, fenoverine, fenpiprane, fenpiverinium bromide, fentoniumbromide, flavoxate, flopropione, gluconic acid, guaiactamine,hydramitrazine, hymecromone, leiopyrrole, mebeverine, moxaverine,nafiverine, octamylamine, octaverine, oxybutynin chloride,pentapiperide, phenamacide hydrochloride, phloroglucinol, pinaveriumbromide, piperilate, pipoxolan hydrochloride, pramiverin, prifiniumbromide, properidine, propivane, propyromazine, prozapine, racefemine,rociverine, spasmolytol, stilonium iodide, sultroponium, tiemoniumiodide, tiquizium bromide, tiropramide, trepibutone, tricromyl,trifolium, trimebutine, n-trimethyl-3, 3-diphenyl-propylamine,tropenzile, trospium chloride, xenytropium bromide, and pharmaceuticallyacceptable salts thereof.

The agent may be associated with the sling 100 in a variety of manners.For example, the agent may be chemically or physically attached to thesurface of the sling 100. In one illustrative embodiment, the surface ofthe sling 100 and the agent, for example, in solution, havecomplementary ionic charges. As such, when placed on the sling 100, theagent ionically bonds to its surface. In another illustrativeembodiment, before application of the agent, the protective treatment isapplied to the sling 100. According to another illustrative embodiment,the protective treatment and the agent are mixed to form a singletreatment and then applied to the sling 100 in a one step process.According to the invention, any suitable process may be employed forassociating the agent with the sling 100, such that the agent can leachto tissue in the region of the implanted sling 100 and/or the protectivetreatment can dissolve and/or leach into the tissue in the region of theimplanted sling 100.

FIGS. 2A-2E show tissue anchors/dilators according to variousillustrative embodiments of the invention. It should be noted that anyof the anchoring structures described herein with radial projections foranchoring, may also be implemented without such projections or with suchprojections, rounded, smoothed or otherwise reduced in side, so as toaccentuate tissue dilation as opposed to tissue anchoring. Thus,although features of the invention may be described below with regardtissue anchors, all such features may be employed with similarly sizedtissue dilators. As also mentioned below, any of the illustrativeanchors/dilators may be configured to be bioabsorbable/biodegradable, sothat they dissolve subsequent to implantation into a patient, leavingonly the sling ends, or other portions of the sling to hold itself inplace. Similarly, as also mentioned below, portions of the sling mayalso be bioabsorbable/biodegradable so it dissolves subsequent toimplantation, leaving scar tissue in its place as a naturally formedsling/platform.

According to various configurations, the below describedanchors/dilators are generally elongated. In some configurations, theanchors/dilators are between about 1 centimeter and about 4 centimeterslong. According to other configurations, the illustrativeanchors/dilators are between about 2.5 centimeters and about 3.5centimeters long. According to additional configurations, theillustrative anchors/dilators have an outside diameter (not includingthe barbs) of between about 2 millimeters and about 4 millimeters.However, in some configurations, the illustrative anchors/dilators ofthe invention have an outside diameter (not including the barbs) of lessthan about 2 millimeters.

As described below, in some of the illustrative embodiments, the tissueanchors/dilators of the invention have relatively smooth outer surfaces,and rely on orientation and/or features on an attached sling foranchoring within the patient's tissues. However, in other illustrativeembodiments, the anchors of the invention include radial projections forresisting removal from a patient's tissue once implanted. The radialprojections may have any of a plurality of configurations. According tosome configurations, the projections form barbs (also referred to astines) that are narrow and bristle-like. In some of theseconfigurations, the bristles are relatively short (e.g., less than about2 millimeters in length). However, in other such configurations, thebarbs are longer (e.g. between about 2 millimeters and about 5millimeters in length). According to some embodiments, the radialprojections have pointed tips. However, in other configurations, theprojections may have rounded tips. According to some illustrativeembodiments, the projections are relatively narrow (e.g., less thanabout 1 millimeter in width/diameter). In other illustrativeembodiments, the projections are relatively wide (e.g., between about 1millimeter and about 2 millimeters in width/diameter). In someinstances, the radial projections are wide enough to extend all the wayaround a circumference of the anchor.

Turning now to the drawings, FIG. 2A depicts a tissue anchor 112 havingdistal 114 and proximal 116 ends. The anchor 112 includes an aperture atthe proximal end 116 for receiving a distal end of a delivery deviceshaft. The aperture may or may not extend through-lumen all the waythrough to the distal end 114. The anchor 112 includes a plurality ofradial projections 118 a-118 c. In this particular embodiment, theprojections 118 a-118 c are formed as a build up of a polymer materialonto an original anchor body. Each of the projections 118 a-118 ccircumscribes the circumference of the anchor 112, and iscurved/oriented to facilitate insertion into tissue, but each alsoincludes a respective proximally facing surface 119 a-119 c (orientedsubstantially normal to the long axis of the anchor 112) for resistingremoval from the tissue. The distal end 114 may have any suitable shape,including being sharpened to pierce tissue or being rounded blunt. Asshown in FIG. 2A, the anchor 112 includes a conical shaped distal end120 for providing tissue dilation during insertion.

As is the case with any of the anchors/dilators described herein, theanchor 112 may be inserted into any suitable soft tissue in a patient,including ligaments, muscles, cartilage, fibro-fatty tissue, organs, andsoft portions of bones or bone coatings. As is also the case with any ofthe tissue anchors/dilators of the invention, the anchor 112 may beformed from any suitable biocompatible material, such as any suitablepolymer material. As described below in more detail, theanchors/dilators may also be coated or otherwise treated with anysuitable material, and may be partially or entirelybiodegradable/bioabsorbable.

FIG. 2B shows an alternative tissue anchor 122. As in the case of theanchor 112, the anchor 122 includes distal 124 and proximal 126 ends,and an aperture at the proximal end 126 for receiving a distal end of adelivery device shaft. As is the case with all of the anchors of FIGS.2A-2E, the aperture may or may not extend as a through-lumen all the waythrough to the distal end 124. The anchor 122 includes a plurality ofradial projections 128 a-128 c, which are similar in configuration tothe radial projections 118 a-118 c, in that they are sloped/oriented tofacilitate insertion into tissue and include proximally facing surfaces129 a-129 c for resisting removal from the tissue. In contrast to theradial projections 118 a-118 c, the radial projections 128 a-128 c aremolded into the body of the anchor 122. Each of the projections 128a-128 c also circumscribes the circumference of the anchor 122. Thedistal end 126 has a similar conical shape to that of the anchor 112.

FIG. 2C shows another illustrative tissue anchor 132 having all of thedescribed properties of the anchors 112 and 122, but having analternative barb configuration. More specifically, the anchor 132includes distal 134 and proximal 136 ends configured similarly to thoseof the anchors 112 and 122. The anchor 123 also includes a conicaldistal tip 144. However, the anchor 132 includes three radially alignedrows of discrete radially projecting barbs. Specifically, the anchor 136includes a first row of radial projecting barbs 138 a-138 c, a secondrow of radially projecting barbs 140 a-140 c, and a third row ofradially projecting barbs 142 a-142 c. According to one feature of thisillustrative embodiment, the barbs also substantially align axially. Forexample, the barbs 138 a, 140 a and 142 a all substantially alignaxially.

Similarly, the barbs 138 b, 140 b, and 142 b also substantially align.The same is the case for the barbs 138 c, 140 c and 142 c. The barbs ofthis embodiment have squared edges and relatively flat surfaces. Theirtips are formed as blunt flat surfaces. As in the prior examples, theyare sloped to facilitate insertion into tissue and to resist removalfrom the tissue.

FIG. 2D shows a further illustrative tissue anchor 146. As in the priorexamples, the anchor 46 includes distal 148 and proximal 150 ends and aconical tip 156. However in this illustrative embodiment, the anchor 146includes two axial rows of barbs as opposed to three, and each rowincludes two barbs; 152 a and 152 b in the first row and 154 a and 154 bin the second row. Another difference in this embodiment is that thebarbs 152 a and 154 a do not align axially. Instead they arerotationally offset from each other. The same is true for the barbs 152b and 154 b. According to the particular illustrative embodiment, thefirst and second rows of barbs are offset from each other by about 90°,but other rotational offsets may be employed. Another feature of theanchor 146 is that the barbs are cut away and peeled back from the bodyof the anchor 146. For example, the barb 152 b is cut away from theanchor body at location 153.

FIG. 2E shows another illustrative tissue anchor 158. The anchor 158 issimilar to the anchor 146 in that it includes distal 160 and proximal162 ends and a conical tip 170. It also includes barbs 164 a, 164 b, 166a, 166 b, 168 a, and 168 b, which are cut away and peeled back from thebody of the anchor 146. However, in the configuration of FIG. 2E, thepeeled back barbs align both in radially and axially extending rows. Forexample, barbs 164 a and 164 b align radially along a circumference ofthe anchor 158, and the barbs 164 a, 166 a, and 168 a all align axially.

In certain illustrative embodiments, any materials described above foruse with the sling 100 may also be used for any of the anchors/dilators.For example, any or all of the anchors/dilators may be configured fromsynthetic materials, non-synthetic materials, or both. Theanchors/dilators may also be configured to bebioabsorbable/biodegradable, either in whole or in part, and suchconfigurations may employ any of the materials referenced above inreference to materials used for the sling 100. Moreover, theanchors/dilaors may be prepared to include a protective coating ortreatment, as described above in reference to the sling 100, and mayalso be configured to contain an agent for release into the patient'stissues, again as described above in reference to the sling 100. Any ofsuch configurations may adopt any of the materials suitable for thesling 100 for use with the anchors/dilators of the invention.

FIGS. 3A-4B show alternative approaches for attaching a sling end to aproximal end of an anchor/dilator, such as the tissue anchors describedabove with regard to FIGS. 2A-2E, those described below with respect toother illustrative embodiments, and their smooth surfaced dilatorcounterparts. FIG. 2A shows an exemplary sling assembly end 180including a sling end 184 and an exemplary tissue anchor 182. As shown,the mesh end 184 wraps around and affixes to a proximal end 186 of theanchor 182. Such affixation may, for example, be by way of gluing, heatbonding, shrink tubing, or any other suitable mechanism. As shown in thecross-sectional view of FIG. 3B, the anchor 184, like the anchors ofFIGS. 2A-2E, includes an aperture 188 in its proximal end 186 forreceiving a distal end of a delivery device shaft. In the alternativeillustrative embodiment of FIGS. 4A and 4B, the anchor 194 includes aslot 196 extending distally from its proximal end 197. As shown in thecross sectional view of FIG. 4B, the slot 196 extends radially acrossthe entire width of the anchor 194 to enable the end 198 of the sling192 to slidably interfit within the slot 196. The slot 196 may beconfigured to be tight enough to capture the sling end 198.Alternatively, it may include one or more textured surfaces or includeprojections for capturing the sling end 198. In other illustrativeembodiments, the sling end 198 may be affixed within the slot 196, forexample, by way of gluing, heat bonding, shrink tubing, or any othersuitable mechanism. As shown in FIG. 4B, the anchor 194 also includes anaperture 199 in its proximal end 197 for receiving a delivery device.

FIGS. 5A-5E depict additional illustrative tissue anchors according tothe invention. Although they are depicted as having hollow bodies (e.g.,a through lumen extending axially from a proximal end to distal end),this need not be the case. Each of the anchors of FIGS. 5A-5E mayinclude any of the operable properties of any other anchors describedherein and may be similarly sized to those of FIGS. 2A-2E. Turning tothe drawings, FIG. 5A shows a hollow anchor 200 including a body 201 andvarious types of barbs 202, which in the illustrated embodiment includespikes and bristles 202. The anchor 200 includes a through-passage 203extending between proximal and distal ends and may attach to a sling,such as the depicted sling 205 by any suitable mechanism. The barbs 202of the anchor 200 are both axially and radially aligned, in a similarfashion to those described above with regard to FIGS. 2A-2E. The barbs202 are relatively short (e.g., less than about 2 millimeters in length)and relatively wide (e.g., between about 1 millimeter and about 2millimeters in width/diameter). Additionally, they have relatively flat(as opposed to pointed) terminal ends 207. According to another feature,the barbs 202 are flexible enough and oriented to compress against thebody 201 of the anchor 200 during insertion, and are oriented to lift upand extend radially from the body 201 to resist removal from the tissue.

FIG. 5B shows a tissue anchor 209 according to another illustrativeembodiment of the invention. In a similar fashion to the anchor 200, theanchor 209 includes an axially extending through passage 206. It alsoincludes radially projecting barbs 208, which are oriented relative tothe body 204 in a similar fashion to the way the projections 202 areoriented relative to the body 201 of the anchor 200. As in the case ofthe projections 202, the projections 208 are also flexible enough todeflect/compress against the body 204 of the anchor 209 during insertioninto tissue and to lift up and resist reverse movement out of thepatient's tissue. The projections 208 are of similar length as, but muchnarrower than the projections 202, being for example less than about amillimeter in diameter/width. As in the case of the anchor 200, theprojections 208 align both axially and radially.

FIG. 5C shows an anchor 210 according to a further illustrativeembodiment of the invention. As shown, the anchor 210 includes athrough-aperture 214, a body 212, and a single row of axially projectingbristles 216 of the type shown at 208 in FIG. 5B. In this illustrativeembodiment, the anchor 210 is but one-third the length of the anchors200 and 209. More particularly, according to the illustrativeembodiment, the anchor 210 is less than about 1.5 centimeters in length.

FIG. 5D shows an anchor 218 according to an alternative embodiment ofthe invention. In this embodiment, the anchor 218 includes athrough-aperture 222, a body 220 and two rows of radial projections 224.The radial projections 224 have the same deflection and tissueengagement properties as those discussed with regard to FIGS. 5A-5D and,like the projections 202 of FIG. 5A, are relatively short (e.g., lessthan about 2 millimeters in length) and relatively wide (e.g., betweenabout 1millimeter and about 2 millimeters in width/diameter).

FIG. 5E shows an anchor 226 according to another alternative embodimentof the invention. As shown, the anchor 226 also includes a throughaperture 230, a body 228 and two rows of radial projections 232. Theonly difference between this embodiment and the embodiment of FIG. 5D isthat the projections 232 are relatively long (e.g., greater than orequal to about 2 millimeters in length) and relatively wide (e.g.,between about 1 millimeter and about 2 millimeters in width/diameter).

FIG. 5F shows an anchor 234 according to a further illustrativeembodiment of the invention. As shown, the anchor 234 includes a body236, an axially extending through-aperture 238 and radial projections240. The anchor 234 has substantially the same properties as the anchors218 and 226 of FIGS. 5D and 5E, respectively, except that the radialprojections 240 are pointed rather than being squared-off like theprojections 202, 224, and 232. According to the illustrative embodiment,the projections have an initial width at a base 237 comparable to thewidth of the projections 224 and 232, and have a length similar to thatof the projections 224. The pointed tips of the projections 240 furtherfacilitate the projections 240 engaging with tissue to oppose beingpulled out of the patient's tissue once implanted.

FIG. 5G shows another illustrative anchor 242, in which the anchorincludes a relatively long (e.g., between about 2.5 centimeters andabout 3.5 centimeters) body 244 and five rows of relatively long (e.g.,greater than about 5 millimeters) radial projections 248. As in the caseof the above described examples, the anchor 242 includes a radiallyextending through-passage 246.

Having described various illustrative tissue anchor configurations,FIGS. 6A-6D show approaches for affixing a soft tissue anchor/dilator toa sling end in such a way as to provide for sling assemblylength/tension adjustment according to various illustrative embodimentsof the invention. More specifically, FIG. 6A shows a sling assembly 250including a sling 252 and an anchor 254. The anchor 254 includes aradial aperture 256, or other suitable aperture, in its side wall nearits proximal end. A first end 260 a of a filament 260 threads throughthe aperture 256, and a second end 260 b of the filament 260 threadsthrough an aperture 258 in the sling end 252 a. The aperture 258 in thesling end 252 a may be, for example, a gap in a mesh or may bepurposefully formed and optionally reinforced. The length of thefilament 260, and thus the overall length of the sling assembly 250(i.e., from anchor/dilator distal tip to anchor/dilator distal tip) maybe adjusted by pulling on the filament terminal ends 260 a and 260 b andsecuring them. In some configurations, they may be secured together, forexample, by clipping, tying, gluing or applying another suitablemechanism. By way of example, in one configuration, the filament ends260 a and 260 b are tied together in a one-way slip knot, which easilyslides to reduce the length of the section of the filament 260 extendingbetween the sling end 252 and the anchor 254, but not to extend thelength of that section.

FIG. 6B shows an adjustable-length sling assembly 262 according toanother illustrative embodiment of the invention. In this illustrativeembodiment, the sling assembly 262 includes a sling 264 and first 266and second 270 tissue anchors. The first tissue anchor 266 affixes to afirst end 268 of the sling 264 in any suitable manner. The second tissueanchor 270 includes a loop 272 at its proximal end. In operation, thesecond end 274 of the sling 264 is inserted through the loop 272 and theanchor 270 is slid into a desired position along the length of the sling264. Once the anchor is in position, the anchor 270 may be secured inplace, for example, with: a snap-fit clip 276 a having, for example, atextured inner surface projection from its inner surface; a vascularclip 276 b; or a staple 276 c. As shown, the clip 276 a or 276 b, or thestaple 276 c, may be placed on the sling 264 next to the anchor 270 onthe sling-end 274 side of the anchor 270 to stop the anchor 270 fromsliding along the sling 264 in a lengthening direction and/or fromsliding off the sling 264 altogether. In other configurations, the loop272 may be sutured, glued or otherwise secured in place on the sling264. Once the anchor 270 is secured, the excess sling material may betrimmed from the sling end 274.

As shown in FIG. 6C, the loop 272 may include angled spikes or teeth 286that are oriented and sized to enable the loop 272, and thus the anchor270, to slide onto the sling 264, but not allow the loop 272 to slide inan opposite (e.g., a lengthening) direction.

FIG. 6D shows another alternative assembly 288 in which a one-way buckle292 is employed to adjust the length/tension of a sling 290. The buckle292 may be similarly shaped to those employed on backpacks, butsized-reduced for the sling 290. As depicted, the buckle 292 includesfirst 294 a and second 294 b slots, defined by a cross bar 296. Thesurfaces forming the first slot 294 a are substantially smooth, whilethe slot 294 b includes a serrated surface 298. In operation, a slingend 290 passes into the slot 294 b from the bottom of the buckle 292over the cross bar 296 and down into the slot 294 a. According to theillustrative embodiment, the buckle 292 may be, or may be attached to,the anchor loop 272. Alternatively, the buckle 292 may be formedintegrally with or otherwise attached to the body of an anchor/dilatorsuch as anchor 270, or its projectionless/projection reduced dilatorcounterpart. In other configurations, the buckle 292 is located on asling end, such as the sling end 290, independent from the sling end 290passing through a loop 272 or other suitable structure on the anchor270. In further configurations, the one-way buckle 292 may be placed atany suitable location along the length of a sling.

FIGS. 7A-7C depict approaches for length/tension adjusting of animplantable sling assembly using filaments, for example, tied in one-wayknots and/or interwoven with the sling material according toillustrative embodiments of the invention. More particularly, FIG. 7Ashows a sling assembly 300 including a sling 302, two tissue anchors 308and 310, and two filaments 312 and 314. As shown, according to theillustrative embodiment, the filament 312 threads through an aperture309 or other suitable structure in the anchor 308. Each end 312 a and312 b of the filament 312 threads through a respective aperture 304 aand 304 b in the sling end 302 a. The further the filament ends 312 aand 312 b are drawn through the sling end apertures 304 a and 304 b, thecloser to the sling end 302 a the anchor 308 is drawn, once againadjusting the overall (e.g., anchor tip to anchor tip) length of thesling assembly 300. As in the prior example, the filament ends 312 a and312 b may be secured together to hold the length of sling assembly 300constant. The filament ends 312 a and 312 b may be secured, for example,by tying, tying in a one-way slip knot (shown at 316), gluing, clipping,crimping, or passing through a one-way adjustable holder, such as theholder 318 or through another suitable mechanism. The anchor 310 may beaffixed directly to the sling end 302 b in any suitable manner or, asshown, tethered to the sling end 302 b in a similar fashion to theanchor 308. More specifically, the filament 314 may be passed throughthe aperture 311 of the anchor 310. The filament ends 314 a and 314 bmay then be passed through respective sling end apertures 306 a and 306b and secured through the one-way suture holder 318. Once the filamentlengths have been adjusted, excess filament may be trimmed off. Anysuitable filament may be employed, including any suitable suturematerial. According to one illustrative embodiment, the sling assembly300 employs a 3-O prolene suture for the filaments 312 and 314.

FIGS. 7B and 7C show a sling assembly 320 in a first elongated state andin a second accordioned state, respectively. Referring first to FIG. 7B,the assembly 320 includes a sling 322, two tissue anchors 328 and 330,and two filaments 332 and 334. As shown, each anchor 328 and 330attaches to a respective sling end 324 and 326 by any suitablemechanism. The filament ends 332 a and 332 b thread through respectiveapertures (which may be openings in a mesh sling material or may bespecifically formed for that purpose) in the sling end 324. Similarly,the filament ends 334 aand 334 b thread through corresponding respectiveapertures in the sling end 326. The filament end 332 a interweaves withthe sling material toward the second sling end 326 along at least aportion of the length of the sling 322 near a first sling edge 325 a.Similarly, the filament end 332 b interweaves with the sling materialtoward the second sling end 326 along at least a portion of the lengthof the sling 322 near a second sling edge 325 b. The filament 334similarly interweaves with the sling material in a direction from thesecond sling end 326 toward the first sling end 324.

Referring also to FIG. 7C, in response to pulling on the terminal ends332 a and 332 b of the filament 332, a section 336 of the sling 322accordions to reduce the length of the sling 322. Similarly, in responseto pulling on the terminal ends 334 a and 334 b of the filament 334, asection 338 of the sling 322 accordions to further reduce the length ofthe sling 322. The filament ends may be secured by any suitablemechanism, including any of those described herein once a desired slinglength is achieved. In some applications, the sling assembly 320 isinserted into the body in the expanded state of FIG. 7B, and shortenedto a desired length subsequent to placement. In other applications, thesling assembly is inserted into the body in the accordioned state ofFIG. 7C, and lengthened to a desired length during placement. In otherapplications, a combination of lengthening and shortening is employedduring sling placement.

In some configurations, an interwoven filament is employed in only oneend of the sling assembly 320, with the other end remaining at a fixedlocation. In some such embodiments, the filament-interwoven, and thusaccordionable sling section may extend for substantially the entirelength of the sling 322. In other illustrative embodiments, the filamentis interwoven with half or less of the length of the sling 322. In someillustrative embodiments, the interwoven filaments pass first through anaperture or other suitable structure on an anchor/dilator, for example,to attach the anchor 328 or 330 to the sling.

FIGS. 8A-8B show perspective and side views, respectively, of a slingassembly 340 including a soft tissue anchor 344 with an internal bar 348about which the length/tension of the sling 342 may be adjustedaccording to an illustrative embodiment of the invention. As shown, ananchor 344 includes a hollow inner portion 346 extending axially from aproximal end 347 at least part way to a distal end 349 of the anchor344, and a bar 348 or other structure extending radially across thehollow portion 346 inside the anchor 344. In this embodiment, a slingend 342 a passes into the hollow portion 346 via a proximal opening inthe anchor 344, loops around the bar 348 and back out of the proximalend 347 of the anchor 349. In some configurations, the bar 348 mayinclude spikes, bristles or other projections, such as those describedabove, for allowing the sling end 342 a to pass through the hollowportion 346 in a sling shortening direction, but impedes the sling 342from passing in an opposite sling lengthening direction. In otherconfigurations, the sling end 342 may be secured, for example, by way ofa clip, staple or suture, outside the anchor 344 (e.g., in a similarfashion to that discussed with reference to FIG. 6B) subsequent to theanchor 344 being placed at a desired location along the length of thesling 342. As in the other illustrative embodiments, excess slingmaterial may be trimmed off subsequent to securing the position of theanchor 344.

FIGS. 9A-9B shows an end of a sling assembly 350, including soft tissueanchor/dilator 352 having a loop 356 for receiving an elongatedridged/jagged element 360 or 366 attached to an end of a sling 362 or364 for providing sling length/tension adjustment according to anotherillustrative embodiment of the invention. As mentioned above and asshown in FIGS. 9A and 9B, the structure 352 need not have any radialprojections, and may instead either rely on orientation for anchoring,or dissolve altogether to leave the sling ends to hold the sling inplace. According to this illustrative embodiment, the elements 360 and366 may have any anchor-like configuration, for example, includingdirectionally oriented spikes, bristles or other projections positionedto slide into the anchor loop 356, and to impede sliding out of the loop356. The anchor/dilator 352 may be slid along the length of theanchor-like element 360 or 366 to adjust the overall (anchor/dilatordistal tip to anchor/dilator distal tip) length of the sling assembly350. The elements 360 and 366 may attach to the respective slings 362and 364 by way of any suitable mechanism, such as any of those employedto attach a tissue anchor/dilator to a sling end.

FIG. 10 shows a sling assembly 370 including two sling assembly sections372 and 374 attached together at an intermediate location 373 to providefor adjustable sling/tension according to another illustrativeembodiment of the invention. According to the illustrative embodiment,the assembly section 372 includes an anchor/dilator end 376 and a freeend 380. Similarly, the assembly section 374 includes an anchor/dilatorend 378 and a free end 382. One or both of the free ends 380 and 382 maybe cut to a desired length, and then attached, for example, by way ofthe clip 384. In other illustrative embodiments, the free ends 380 and384 are attached, for example, by way of suturing, tying, stapling,gluing or heat melting/bonding, or other suitable mechanism.

FIG. 11 shows another two-section adjustable length/tension slingassembly 386. As in the case of the illustrative embodiment of FIG. 10,the assembly section 388 includes an anchor/dilator end 392 and a freeend 393, and the assembly section 390 includes an anchor/dilator end 394and a free end 395. The assembly section 388 also includes bristles,spikes or tangs 398 extending from its edges along at least a portion ofits length. The bristles may be formed, for example, from sling meshfilaments, which optionally are treated to stiffen them. In otherembodiments, the bristles may be bonded to the edges of the slingassembly section 388. The assembly section 390 includes an aperture 396near its free end 395. The aperture 396 may be, for example, a gapbetween filaments of a mesh sling material or may be purposefullyformed, and optionally reinforced.

In operation, the anchor/dilator end 392 interfits through the aperture396. The aperture 396 is sized to be large enough to pass theanchor/dilator end 392 but small enough to engage the projections 398.The projections 398 are oriented for and flexible enough to pass throughthe aperture 396 behind the anchor/dilator end 392 in the direction ofthe arrow 397, but inhibit the assembly section 388 from sliding backthrough the aperture 396 in the direction of the arrow 399.

FIGS. 12A-12B show an end of an adjustable length/tension sling assembly400, including a sling 408 having an end 406 and employing a soft tissueanchor/dilator 402 with a loop section 404 according to anotherillustrative embodiment of the invention. As shown in FIG. 12B, thesling 408 may be secured within the loop 404 by placing any suitablesecuring mechanism 410 next to the loop 404 on the free end 406 side ofthe anchor/dilator 402, in a similar fashion to that described withregard to FIG. 6B. However, as shown in the alternative embodiment ofFIG. 12A, the clip 410 may be placed around both the sling 408 and theend section 406. In some implementations, the securing mechanism of FIG.12A may be a suitably-sized elastic band or O-ring. In this way, thefastener 410 need not be a permanent fastener and may continue to allowfor sling length adjustment even after the fastener 410 is slid intoplace, in much the same way as a buckle arrangement would allow.

FIGS. 13A-13B depict soft tissue anchor/dilator 412 having a buckleformed in a side wall for interthreading with an end of a sling, such asthe end 424 of the sling 422, to provide for adjustable slinglength/tension according to an additional illustrative embodiment of theinvention. As shown in FIGS. 13A and 13B, the anchor 420 includes athrough-passage 420 extending between proximal 421 and distal 423 endsof the anchor/dilator 412. The anchor/dilator 412 also includes twosubstantially rectangular through-apertures 414 and 418 in the wall ofthe anchor/dilator 412. The apertures 414 and 418 are separated by across bar 416. As shown in FIG. 13B, the sling end 424 threads into thethrough-passage 420 at the proximal end 421 of the anchor/dilator 412.It then exits the through-passage 420 through the aperture 414, loopsover the cross bar 416, and re-enters the through-passage 420 throughthe aperture 418. By pulling on the sling end 424 in the direction ofthe arrow 425, the length of the sling 422 may be shortened. Similarly,by feeding the end 424 in an opposite direction, the sling 422 may belengthened. The buckle structure of FIGS. 13A and 13B may also includeany of the operable features described above with regard to FIG. 6D.Additionally, although the passage 420 is depicted and described as athrough-passage, this need not be the case.

FIGS. 14A-14B depict a sling assembly 426 employing an arrangement ofinterlocking, stackable soft tissue anchors/dilators 430, 440 and 446for providing adjustable sling assembly length/tension according toanother embodiment of the invention. As shown in FIG. 14A, a firsttissue anchor/dilator 430 attaches to an end of a sling 428 in anysuitable manner and includes opposing apertures 434 a and 434 b in itsside wall near a proximal end. It also includes small radially extendingbarbs 436 a and 436 b in its side wall near a distal end 433. Theanchor/dilator 430 also includes tissue engaging projections 432 of thetype described above. Similarly, the anchor/dilator 440 includesopposing apertures 438 a and 438 b in its side wall near its proximalend 441, axially extending barbs 444 a and 444 b in its side wall nearits distal end 443. As may be the case with any of the anchor/dilatorstructures discussed herein, the anchor/dilator 440 includes no tissueengaging projections. In operation, the proximal end 441 of theanchor/dilator 440 interfits over the distal end 433 of theanchor/dilator 430, with the barbs 436 a and 436 b snap fitting into theapertures 438 a and 438 b. In this way the two anchors/dilators 430 and440 may be stacked to extend the overall length of the sling assembly426.

In a similar fashion, the anchor/dilator 446 includes apertures 452 aand 452 b in its side wall near its proximal end 457 and radiallyprojecting barbs 450 aand 450 b in its side wall near its distal end453. It also includes tissue-engaging barbs 448. In operation, theproximal end 457 of the anchor/dilator 446 can interfit over the distalend 443 of the anchor/dilator 440, with the proximal apertures 452 a and452 b snap fitting onto the radial projections 444 a and 444 b tofurther extend the anchoring/dilating mechanism and further increase theoverall length of the sling assembly 426. According to another feature,the anchors/dilators 446 and/or 440 may also be removed from theanchor/dilator 430 to shorten the sling assembly 426. According to oneillustrative embodiment, each of the anchors/dilators 430, 440 and 446may be between about 2 centimeters and about 4 centimeters long.Additionally, they may be of differing sizes to provide for differingincrements by which to adjust the sling-assembly length. The same orsimilar anchor/dilator configuration may be employed at the other end ofthe sling assembly 426, or alternatively, the other end of the slingassembly may employ a fixed length configuration.

FIGS. 15A-15B show a delivery device 460 for delivering a sling to ananatomical site within the body of a patient. The illustrative deliverydevice 460 includes a handle 466 and a shaft 464. The handle 466includes a proximal end 468 and a distal portion 470 and extendssubstantially along an axis 472. The handle 466, as depicted, issubstantially straight and tapers inward from the proximal end 470 to adistal location 474. The distal portion 470 of the handle 466 tapersoutward from the distal location 474 to help prevent a medicaloperator's hand from slipping distally while using the device bygrasping the handle 466. The shaft 464, as depicted, includes a firstsubstantially straight proximal portion 476 attached to and extendingdistally from the distal end 470 of the handle 466, substantially alongthe axis 472. The illustrated shaft 464 also includes a curved portion478 that extends distally from and curves away from the substantiallystraight proximal portion 476, and a second substantially straightportion 480 extending distally from the curved portion 478 andsubstantially along an axis 482. In illustrative embodiments, the axis472 and 482 form a non-orthogonal angle relative to each other and liesubstantially in a single plane. However, this need not be the case, andany suitable angle may be employed with the invention.

In certain embodiments, the shaft 464 may be, for example, substantiallystraight or may include one or more curved sections. Additionally, theshaft 464 may lie substantially in one plane or may be shaped to lie inmultiple planes. The shaft 464 may be of substantially constant outsidediameter 484 or may include portions of differing outside diameters. Invarious embodiments, the shaft 464 may include hooked and/or helicalportions. The shaft may also be configured in various ways and/orinclude various features as described in the patents and patentapplications mentioned and incorporated by reference herein.

FIG. 15B shows a magnified view of the distal section 486 of the shaft464. The distal section 486 includes part of the substantially straightsection 480 having an outside diameter 484, and a reduced diameterdistal section 488 extending distally from the section 480 and having anoutside diameter 490. The distal section 488 terminates in a distal tip492. In illustrative embodiments, the diameter 490 is substantiallysmaller than the diameter 484, forming a radially extending shoulder 494between the section 488 and the section 480. According to one feature,the shoulder 494 inhibits or impedes a tissue anchor/dilator located atthe end of a sling assembly slidably engaged or associated with thesection 488 from sliding proximally along the curved section 478 andfirst straight section 476 of the shaft 464 during implantation of thesling assembly. The distal tip 492 may be sharp enough to pierce tissue,or alternatively, relatively blunt. Additionally, the distal tip 492 mayhave a conical or any other suitable shape.

In one configuration, the shoulder 494 extends around the entirecircumference of the shaft 464. In other configurations, the shoulder494 extends around only a portion of the circumference. In both cases,the shoulder 494 extends far enough to provide a protuberance ofsufficient size to impede the sling assembly end from sliding proximallyalong a substantial portion of the length of the shaft 464.

In alternative illustrative embodiments, the portion 488 may tapertowards the distal end 492, or may have constant outside diameter 490,except, for example, for a conical tip. In other embodiments, theportion 486 may have an outside diameter that gradually decreasesdistally, instead of an abrupt decrease in outside diameter, such as theabrupt decrease between diameters 484 and 490 depicted in FIG. 1B.

According to various illustrative embodiments, the length 496 of thesection 488 is between about 2 centimeters and about 4 centimeters long.In other illustrative embodiments, it is between about 1 centimeter andabout 3 centimeters long. In further illustrative embodiments, thenarrowed distal portion 488 has an outside diameter 490 of between about0.03 inches and about 0.05 inches. In one illustrative embodiment, ithas an outside diameter 490 of about 0.04 inches. According to otherconfigurations, the portion 480 of the shaft 464 forming the shoulder494 has an outside diameter 484 of between about 0.07 inches and about0.1 inches. In one implementation, the outside diameter 484 of thisportion 480 of the shaft is about 0.09 inches. According to oneconfiguration, the total length of the shaft 464 is between about 7centimeters and about 20 centimeters. In other configurations, the totallength of the shaft 464 is between about 8 centimeters and about 12centimeters.

FIG. 16 shows a delivery device 500 for delivering a sling assembly toan anatomical location in the body of a patient according to anotherillustrative embodiment of the invention. The illustrative deliverydevice 500 includes a handle 502, a fixed position cannula 504 and amovable shaft 506. The handle 502 includes a proximal end 508 and adistal portion 510. The handle 502, as depicted, is substantiallystraight and tapers inward from the proximal end 508 to a distallocation 512. The distal portion 510 of the handle 502 tapers outwardfrom the distal location 512 to help prevent a medical operator's handfrom slipping distally while grasping the handle 502. The cannula 504has a proximal end 504 a and distal end 504 b, and extends distally froma distal most end 514 of the handle 502. The cannula 504 issubstantially straight, but this need not be the case. In alternativeembodiments, it may include any combination of curved sections andstraight sections, and may extend into one, two or more planes. Theshaft 506 interfits within the cannula 504 and mechanically couples at aproximal end to a slider 516 on the handle 502. An operator may slidethe slider 516 axially within the slot to retract and extend the shaft505 in and out of the cannula 504. With the shaft 506 extended, a distalmost end 520 of the cannula 504 forms a shoulder 522 similar to theshoulder 494 formed between the shaft sections 480 and 488 of FIGS. 15Aand 15B. According to some embodiments, the distal end of the shaft 506may be sized and shaped similarly to the shaft section 488, while thecannula 504 may be sized and shaped similarly to any of the shaftsections 476, 478 and 480.

In operation, a tissue anchor/dilator of a sling assembly of the typedescribed above interfits onto the distal end of the shaft 506 with theslider 516, and thus the shaft 506, in an extended position. The distalend of the delivery device 500, with a tissue anchor/dilator sointerfitted may then be inserted into the body of a patient, forexample, by way of an incision in the vaginal wall. The delivery deviceis advanced until the interfitted anchor/dilator is placed at a desiredlocation. The slider 512 is then retracted to retract the shaft 506 intothe cannula 504 and out of the tissue anchor/dilator. The deliverydevice is then removed from the patient to leave the tissueanchor/dilator and sling-assembly end placed at the desired locationwithin the patient. The procedure may be employed with the other end ofthe sling assembly on the contralateral side of the body with the sameor a different delivery device.

According to the illustrative embodiment, in an extended position, theexposed distal section of the shaft 506 is between about 2 centimetersand about 4 centimeters long. In other illustrative embodiments, it isbetween about 1 centimeter and about 3 centimeters long. In furtherillustrative embodiments, the narrowed distal section of the shaft 506has an outside diameter of between about 0.03 inches and about 0.05inches. In one illustrative embodiment, it has an outside diameter ofabout 0.04 inches. According to other configurations, the outsidediameter of the cannula 504 at the distal end 520 is between about 0.07inches and about 0.1 inches. In one implementation, the outside diameterof this portion of the cannula is about 0.09 inches. According to oneconfiguration, the total distance from the distal end 514 of the handle502 to the distal most tip 506 a of the shaft 506, with the shaftextended is between about 7 centimeters and about 20 centimeters. Inother configurations, the total distance is between about 8 centimetersand about 12 centimeters.

FIG. 17 shows a delivery device 524 for delivering a sling assembly toan anatomical location in the body of a patient according to anotherillustrative embodiment of the invention. The illustrative deliverydevice 524 includes a handle 526, a fixed position shaft 528 and amovable pusher assembly 530. The handle 526 includes a proximal end 532and a distal portion 536. The handle 526 is substantially straight andtapers inward from the proximal end 532 to a distal location 534. Thedistal portion 536 of the handle 526 tapers outward from the distallocation 534 to help prevent a medical operator's hand from slippingdistally while grasping the handle 525.

The pusher assembly 530 includes a user actuator 538 and to a cannula540 extending distally from the user actuator 538 and over the shaft528. The cannula 540 has a proximal end 540 a and a distal end 540 b,and is substantially straight, but this need not be the case. Inalternative embodiments, the cannula 540 and the shaft 528 many includeany combination of curved sections and straight sections, and may extendinto one, two or more planes. An operator may slide the pusher actuator538 axially to extend and retract the cannula 540 over the shaft 528 toalternatingly cover and uncover the distal end 528 a of the shaft 528.With the cannula 540 retracted, a distal-most end 540 b of the cannula540 forms a shoulder 542 similar to the shoulder 494 formed between theshaft sections 480 and 488 of FIGS. 15A and 15B. According to someembodiments, the distal end of the shaft 528 may be sized and shapedsimilarly to the shaft section 488, while the cannula 540 may be sizedand shaped similarly to any of the shaft sections 476, 478 and 480.

In operation, a tissue anchor/dilator of a sling assembly of the typedescribed above interfits onto the distal end of the shaft 528 with thepusher actuator 538, and thus the cannula 540, in a retracted position.The distal end of the delivery device 524, with a tissue anchor/dilatorso interfitted may then be inserted into the body of a patient, forexample, by way of an incision in the vaginal wall. The delivery deviceis then advanced until the interfitted anchor/dilator is placed at adesired location. The pusher actuator 538 is then slid distally alongthe shaft 528 to cause the shoulder 542 of the cannula 540 to abut aproximal end of the anchor/dilator and push it off the distal end of theshaft 528. The delivery device 524 is then removed from the patient toleave the tissue anchor/dilator and sling-assembly end placed at thedesired location within the patient. The procedure may be employed withthe other end of the sling assembly on the contralateral side of thebody with the same or a different delivery device.

According to the illustrative embodiment, with the pusher assembly 530in a retracted position, the exposed distal section of the shaft 528 isbetween about 2 centimeters and about 4 centimeters long. In otherillustrative embodiments, the exposed distal section of the shaft 528 isbetween about 1 centimeter and about 3 centimeters long. In furtherillustrative embodiments, the narrowed distal section of the shaft 506has an outside diameter of between about 0.03 inches and about 0.05inches. In one illustrative embodiment, it has an outside diameter ofabout 0.04 inches. According to other configurations, the outsidediameter of the cannula 540 at the distal end 540 b is between about0.07 inches and about 0.1 inches. In one implementation, the outsidediameter of this portion of the cannula is about 0.09 inches. Accordingto one configuration, the total distance from the distal end of thecannula 540 to the distal most tip 528 a of the shaft 528, with thepusher assembly 530 retracted is between about 7 centimeters and about20 centimeters. In other configurations, the total distance is betweenabout 8 centimeters and about 12 centimeters.

FIG. 18 shows a delivery system 550 for implanting a sling assembly 552at an anatomical location within the body of a patient according toanother illustrative embodiment of the invention. The delivery system550 includes a dilator 554, a pusher 556, and a guide member 558. Thedilator 550 is a hollow tube having an aperture 562 at a distal end 564,an aperture 566 at a proximal end 568 and through-lumen 570 extendingtherebetween. The depicted dilator is substantially straight, yet thisneed not be the case. In alternative embodiments, it may include anycombination of curved and/or straight sections, and may extend into one,two or more planes. As depicted, the dilator 554 has a conical distalend 564 for dilating tissue during tunneling and terminating in a tipthat is sharp enough to pierce tissue. However, in other embodiments,the distal end may be dulled or have any other suitable configuration.The dilator 554 may be substantially rigid or flexible. Preferably, itis rigid enough to tunnel through tissue without bending or otherwisedeflecting. The guide member 558 is sized and shaped to interfit withand axially pass through the dilator lumen 570. The guide member 558 maybe substantially rigid or flexible enough to accommodate any curves orbends in the dilator 554.

The pusher 556 includes a handle 560 and a cannula 562. The handle 560includes a distal end 572, a proximal end 574 and a through-lumen 576extending axially there between. The cannula 562 extends axially fromthe distal end 572 of the handle 560, and includes a distal end 578, aproximal end 580, and a through-lumen extending therebetween. Thethrough-lumen of the cannula 562 axially aligns with the through-lumen576 of the handle 560.

In operation, the dilator 554 is inserted at the distal end 564 firstthrough an incision, for example, in the vaginal wall of a patient untilthe distal tip 564 reaches a location at or near to the anatomical siteat which the anchor 582 of the sling assembly 552 is to be implanted.The guide member 558, optionally a guide wire, is inserted axially intothe proximal aperture 566 of the dilator 554 and advanced through thedilator lumen 570 and out the distal aperture 562. Optionally, thedistal end 584 of the guide member 558 may be extended into the tissueof the patient past the anatomical site at which the anchor 582 is to beimplanted. The dilator 554 is then slid proximally along the guidemember 558 to remove it from the patient's body. The hollow anchor 582of a sling assembly 552 is then slid distal end first over a proximalend 586 of the guide member 558, and slid distally along the guidemember 558. The distal end 578 of the cannula 562 of the pusher 556 isthen slid over the proximal end 586 of the guide member 558, and sliddistally along the guide member 558 to abut the distal end 578 of thecannula 562 against a proximal end of the anchor 582. The pusher 556 isthen slid farther distally along the guide member 558 to advance thetissue anchor 582 along the guide member 558 until it reaches thedesired implantation location within the body of the patient. The pusher556 and the guide member 558 may then be removed to leave the tissueanchor 582 and the corresponding end of the sling assembly 552 in place.The delivery system 550 is discussed further below with reference toFIGS. 23A-23C, 25A-25C, and 26A-26B.

FIGS. 19A-19B show a delivery system 600 for implanting a sling assembly602 including a soft tissue anchor/dilator to an anatomical site in thebody of a patient according to another illustrative embodiment of theinvention. As shown, the delivery system 600 includes a hollow insertionshaft 606 and a push wire 608. The insertion shaft 606 may be configuredsimilarly to the dilator 554 of FIG. 18 and includes a distal aperture610, a proximal aperture 612 and a through-lumen extending therebetween. The push wire 608 has proximal 614 and distal 616 ends and maybe of any suitable length. The push wire 608 may be configured as asubstantially rigid rod or may be flexible enough to accommodate anycurves in the insertion shaft 606.

In operation and as shown in FIG. 19B, the tissue anchor 604 of thesling assembly 602 interfits over a distal end 618 of the insertionshaft 606. The distal end 618 of the shaft 606, with the anchor 604 sointerfitted, is inserted into the body of the patient, for example via avaginal wall incision, and advanced distally until the anchor 604 ispositioned at the desired implantation site. The push wire 608 is theninserted at distal end 614 first into the proximal aperture 612 of theshaft 606 and advanced distally through the shaft 606 until the distalend 614 of the push wire 608 abuts the tissue anchor 604 and pushes itoff the insertion shaft 606 to implant the anchor 604 and the associatedsling assembly end at the desired anatomical location. The insertionshaft 606 and the push wire 608 may then removed from the patient.

FIG. 20 shows a delivery system 620 for delivering a tissueanchor/dilator of a sling assembly 624 to an anatomical location in thebody of a patient according to a further illustrative embodiment of theinvention. The delivery system 620 includes a delivery device 626 havinga handle 628 and a shaft 630 extending distally from a distal end 632 ofthe handle 628. According to this illustrative embodiment, the shaft 630includes a first straight section 634 extending distally from the distalend 632 of the handle 628 and a spiral section 636 extending andspiraling away from the first straight section 634. The spiral section636 extends into more than two planes and terminates distally in asecond straight section, the tip 636 of which is shown extending fromthe hollow anchor 622. Although not shown, the illustrative shaft 630forms a shoulder between the second straight section and the spiralsection 636 near the proximal end 638 of the 622. This shoulder issimilar to the shoulder 494 of the device 460 of FIGS. 15A and 15B. Thesystem 620, with the shaft 630 inserted into the anchor 636 may beemployed, for example, to deliver the anchor, and thus the associatedsling assembly end, to or through a obturator membrane via an inside out(e.g., insert through an incision in the vaginal wall rather than anincision in the inner thigh) transobtural procedure.

FIG. 21 shows another illustrative delivery 640 device particularlysized and shaped for transobtural placement of an implantable slingemploying a soft tissue anchor/dilator, such as the anchors/dilatorsdescribed above. The delivery device 640 includes a handle 642, a shaft644, and a transitional portion 646 extending distally between a distalend 642 a of the handle 642 and a proximal end 648 of the shaft 644. Thetransitional portion 646 includes a first straight section 646 a, acurved section 646 b, and a second straight section 646 c, all lyingsubstantially in a single plane, and may be formed as either part of theshaft 644 or as part of the handle 642. The shaft 644 includes a curvedsection 644 a, a straight section 644 b and a reduced diameter section644 c, all lying substantially in the same plane as the transitionalportion 646. In the illustrative embodiment, the first straight section646 a of the transitional portion 646 attaches to the distal end 642 aof the handle 642, extends distally along a first axis 650, andpreferably has a substantially constant diameter. The curved section 646b of the transitional portion 646 extends from a distal end of the firststraight section 646 a, curves away from the first axis 650, and alsopreferably has a substantially constant diameter. The second straightsection 646 c extends from a distal end of the curved section 646 balong a second axis 652, and preferably has a diameter that decreasesfrom its proximal end to its distal end to provide increased structuralstability to the shaft 644. The curved section 644 a, preferably, has asubstantially constant diameter, smaller than the diameter of the curvedsection 646 b of the transitional portion 646, and extends from thedistal end of the second straight section 646 c of the transitionalportion 646, curves back toward the first axis 650, and terminates at adistal end approximately at an intersection with the first axis 650. Thestraight section 644 b, preferably, has a substantially constantdiameter and extends from the distal end of the curved section 644 aalong a third axis 656, which crosses the first axis 650. According tothe illustrative embodiment, the reduced diameter section 644 c extendsdistally from the straight section 644 b. In various illustrativeembodiments, the dimensions for the shaft 644 may be the same or similarto those discussed with regard to the shaft 464 of FIGS. 15A and 15B.For example, the outside diameters of the second straight section 644 band the reduced diameter section 644 c may be the same or similar to thedimensions given for the shaft section 480 and reduced diameter shaftsection 488, respectively. Similarly, the length of the section 644 cmay also be the same or similar to the length ranges given for the shaftsection 488.

FIGS. 22A-22C shows another illustrative delivery device 660particularly sized and shaped for transobtural placement of animplantable sling, and employable, without limitation, with any of theillustrative embodiments described herein. More particularly, thedelivery devices 660 includes a handle 662 with first 662 a and second662 b substantially straight sections located substantially in a firstplane and angled relative to each other, a transitional portion 665extending out of a distal end 663 of the handle 662, and a shaft 664extending from a distal end of the transitional portion 665. The shaft664 includes curved section 664 a, a straight section 664 b, andterminates in a reduced diameter section 604 c, comparable to thereduced diameter sections 488 and 644 c of FIGS. 15B and 21,respectively.

The transitional portion 665 interfits and extends axially out of thedistal end 663 of the second straight handle section 662 b to affix theshaft 664 to the handle 662. As a result, the transitional portion 665is substantially co-planer with the handle 662 in the first plane. Thecurved section 664 a of the shaft 664 extends from a distal end of thetransitional portion 665. The straight section 664 b of the shaft 664extend from a distal end of the curved section 664 a. The curved section664 a and the straight section 664 b are substantially coplanar in asecond plane. According to the illustrative embodiment of FIGS. 22A-22C,the first and second planes are substantially orthogonal to each other.However, the first and second planes may be at any suitable angle (e.g.,about 10, 20, 30, 45, 60, 70 or 80 degrees) to each other.

To provide structural reinforcement, the sections 662 a and 662 b have across sectional diameter that tapers to be smaller at the distal end 603of the handle 602. Additionally, rather than having a taperedtransitional portion 665, the transitional portion 655 is formed as partof the shaft 604, as shown in FIG. 22A, the tapered portions 662 b and662 b of the embodiment of FIGS. 22A-22C are formed as part of thehandle 662. According to one feature, this configuration reduces thelength of the transitional portion 665 and thus, provides improvedstructural support for the curved section 664 a. Preferably, inoperation, neither the handle 662 nor the intermediate/transitionalportion 665 extends into the body of the patient, and provides apositive stop against this occurring.

FIGS. 23A-23C illustrate an approach for delivering a sling assemblytransobturally using the delivery system 550 of FIG. 18 according to anillustrative embodiment of the invention. Referring also to FIG. 18, asshown in FIG. 23A, the dilator 554 is inserted distal end 564 firstthrough an incision, for example, in the vaginal wall of a patient untilthe distal tip 564 reaches an obturator foramen 670. With reference toFIGS. 23A and 23B, the guide member 558 is then inserted axially intothe proximal aperture 566 of the dilator 554 and advanced through thedilator lumen 570 and out the distal aperture 562 into the obturatorforamen 670. The dilator 554 is then slid proximally along the guidemember 558 to remove it from the patient's body. As shown in FIG. 23B,the hollow anchor 582 of the sling assembly 552 is then slid, distal endfirst, over a proximal end 586 of the guide member 558, and sliddistally along the guide member 558. The distal end 578 of the cannula562 of the pusher 556 is then slid over the proximal end 586 of theguide member 558, and slid distally along the guide member 558 to abutthe distal end 578 of the cannula 562 against a proximal end of theanchor 582. The pusher 556 is then further slid distally along the guidemember 558 to advance the tissue anchor 582 along the guide member 558until it enters the obturator foramen 670. As shown in FIG. 23C, thepusher 556 and the guide member 558 are then removed to leave the tissueanchor 582 and the corresponding end of the sling assembly 552 in placein the obturator foramen 670. As shown in FIG. 23C, the procedure isrepeated on the other side of the body to implant the second anchor 583and its associated sling assembly end in the obturator foramen 672.

According to the illustrative embodiment of FIGS. 23A-23C, the anchors582 and 583 are delivered through respective obturator membranes toabout 2.5 cm into the obturator foramen. However, in other illustrativeembodiments, the anchors 582 and 583 are delivered through therespective obturator membranes about 1 centimeter to about 2.5centimeters into the obturator formen. The anchors 582 and 583 may alsobe fixed to the obturator membrane.

FIGS. 24A-24C depict an approach for delivering a sling assembly 702transobturally using the delivery system of FIGS. 22A-22C according toan illustrative embodiment of the invention. The delivery device 664 isemployed to describe this embodiment. However, the delivery device 640may be employed in a similar fashion. Additionally, as in the previouslydescribed embodiment, the barbed tissue anchor, may be replaced with arelative smooth tissue anchor and/or with a anchor-sized tissue dilator.To begin, an incision is made in the anterior vaginal wall and dissectedbilaterally to the interior portion of the inferior pubic ramus. Thesoft tissue anchor 704 attached to an end of the sling 706 isinterfitted over the reduced diameter portion 664 c of the deliverydevice shaft 664. Referring to FIGS. 24A and 24B, a medical operatorgrasps the handle 662 and inserts the delivery device shaft portion 664c with the anchor 102 installed through the vaginal incision. With alateral motion, the medical operator passes the curved portion 664 a ofthe shaft 664 behind the ischiopubic ramus 712 and pierces the obturatormembrane 708. The delivery device shaft 664 can then be withdrawn fromthe body leaving the anchor 704 implanted in or through the obturatormembrane 708 and, optionally, fixed to the obturator membrane 708. Asindicated in FIG. 24C, this process is repeated with the same or asecond delivery device having an opposite curvature and the second softtissue anchor 705 to implant the second soft tissue anchor 705 in orthrough the obturator membrane 714 on the contralateral side of thebody. As shown in FIG. 24C the sling 706 forms a supportive platformunder the urethra 716.

FIGS. 25A-25C show a more detailed view of how an anchor/dilator may beplaced in the obturator membrane 670 using the procedure of FIGS.23A-23C according to an illustrative embodiment of the invention. Asshown in FIGS. 23A-23C, the anchor 582 is placed over the guide member558, which has been previously inserted through the obturator membrane670. Then, the pusher 556 is advanced behind it to advance the anchor582 distally along the guide member 558. As seen in the illustrativeembodiment of FIG. 23C, the anchor 552 may be advanced into theobturator membrane 670. The radial projections on the anchor 582 inhibitthe anchor 582 from being retracted out of the membrane 670 onceinserted. Regardless of the procedure employed, the anchor 582 may beadvanced into the membrane until the desired sling tension is achievedunder the urethra. Alternatively, any of the above described approachesmay be employed to adjust sling tension.

FIGS. 26A-26B show a detailed view of an alternative placement of a softtissue anchor/dilator of a sling assembly according to anotherillustrative embodiment of the invention. In this embodiment, ananchor/dilator 800 includes aperture 802 in its side wall about midwayalong its length, for example, similar to the buckle arrangement ofFIGS. 13A and 13B. As shown in FIG. 26B, subsequent to being advancedalong the guide member 558 through the obturator membrane 670 and theguide member 558 being removed, tension applied to the sling 804 causesthe anchor 800 to pivot horizontally until braced against the obturatormembrane 670. The lengthwise orientation of the anchor 800 furtherprevents withdrawal of the anchor 800 and ensures that the sling 804will be held securely in place. As mentioned above, in someimplementations, the anchor/dilator 800 may dissolve to leave only thesling end embedded in the obturator membrane to hold the sling in place.

Variations, modifications, and other implementations of what isdescribed may occur without departing from the spirit and the scope ofthe invention. By way of example, and without limitation, examples ofslings, sling assemblies, sling delivery devices and approaches, slingassembly-to-delivery device association mechanisms, and sling anchoringmechanisms including features that may be employed with the abovedescribed invention are disclosed in U.S. Pat. No. 6,042,534, entitled“Stabilization sling for use in minimally invasive pelvic surgery,” U.S.Pat. No. 6,755,781, entitled “Medical slings,” U.S. Pat. No. 6,666,817,entitled “Expandable surgical implants and methods of using them,” U.S.Pat. No. 6,042,592, entitled “Thin soft tissue surgical support mesh,”U.S. Pat. No. 6,375,662, entitled “Thin soft tissue surgical supportmesh,” U.S. Pat. No. 6,669,706, entitled “Thin soft tissue surgicalsupport mesh,” U.S. Pat. No. 6,752,814, entitled “Devices for minimallyinvasive pelvic surgery,” U.S. Ser. No. 10/918,123, entitled “SurgicalSlings,” U.S. patent application Ser. No. 10/641,376, entitled “Spacerfor sling delivery system,” U.S. patent application Ser. No. 10/641,192,entitled “Medical slings,” U.S. Ser. No. 10/641,170, entitled “Medicalslings,” U.S. Ser. No. 10/640,838, entitled “Medical implant,” U.S.patent application Ser. No. 10/460,112, entitled “Medical slings,” U.S.patent application Ser. No. 10/631,364, entitled “Bioabsorbable casingfor surgical sling assembly,” U.S. Ser. No. 10/092,872, entitled“Medical slings,” U.S. patent application Ser. No. 10/939,191, entitled“Devices for minimally invasive pelvic surgery,” U.S. patent applicationSer. No. 10/774,842, entitled “Devices for minimally invasive pelvicsurgery,” U.S. patent application Ser. No. 10/774,826, entitled “Devicesfor minimally invasive pelvic surgery,” U.S. Ser. No. 10/015,114,entitled “Devices for minimally invasive pelvic surgery,” U.S. patentapplication Ser. No. 10/973,010, entitled “Systems and methods for slingdelivery and placement,” U.S. patent application Ser. No. 10/957,926,entitled “Systems and methods for delivering a medical implant to ananatomical location in a patient,” U.S. patent application Ser. No.10/939,191, entitled “Devices for minimally invasive pelvic surgery,”U.S. patent application Ser. No. 10/918,123, entitled “Surgical slings,”U.S. patent application Ser. No. 10/832,653, entitled “Systems andmethods for sling delivery and placement,” U.S. patent application Ser.No. 10/642,397, entitled “Systems, methods and devices relating todelivery of medical implants,” U.S. patent application Ser. No.10/642,395, entitled “Systems, methods and devices relating to deliveryof medical implants,” U.S. patent application Ser. No. 10/642,365,entitled “Systems, methods and devices relating to delivery of medicalimplants,” U.S. patent application Ser. No. 10/641,487, entitled“Systems, methods and devices relating to delivery of medical implants,”U.S. patent application Ser. No. 10/094,352, entitled “System forimplanting an implant and method thereof,” U.S. patent application Ser.No. 10/093,498, entitled “System for implanting an implant and methodthereof,” U.S. patent application Ser. No. 10/093,450, entitled “Systemfor implanting an implant and method thereof,” U.S. patent applicationSer. No. 10/093,424, entitled “System for implanting an implant andmethod thereof,” U.S. patent application Ser. No. 10/093,398, entitled“System for implanting an implant and method thereof,” and U.S. patentapplication Ser. No. 10/093,371, entitled “System for implanting animplant and method thereof,” the entire contents of all of which areincorporated herein by reference.

1. An implantable sling for treating urinary incontinence comprising, anelongated sling having first and second terminal ends, the first endhaving a first portion folded over onto a portion of a length of thesling to form a first pocket in the first end, and the second end havinga second portion folded over onto a portion of the length of the slingto form a pocket in the second end.
 2. The implantable sling of claim 1,wherein the first and second pockets are sized and shaped for receivinga distal end of a delivery device shaft.
 3. The implantable sling ofclaim 1, wherein the first portion has first and second long edgesaffixed to first portions of corresponding long edges of the sling, andthe second portion has first and second long edges affixed to secondportions of the corresponding long edges to form the first and secondpockets.
 4. A soft tissue anchor comprising an elongated body having anaperture in a proximal end and a passage extending axially in a distaldirection at least part way to a distal end of the elongated body, and aplurality of barbs projecting radially from an external surface of theelongated body, wherein the elongated body is between about 2.5 and 3.5cm long.
 5. The soft tissue anchor of claim 4, wherein the barbs arebetween about 2 mm and about 5 mm in length.
 6. The soft tissue anchorof claim 4, wherein the barbs are between about 1 mm and about 2 mm inwidth at a maximum width location.
 7. The soft tissue anchor of claim 4,wherein the barbs have a maximum width of less than about 1 mm.
 8. Thesoft tissue anchor of claim 4, wherein the barbs are arranged in one ormore substantially radially aligned rows.
 9. The soft tissue anchor ofclaim 4, wherein the barbs are arranged in one or more substantiallyaxially aligned rows.
 10. The soft tissue anchor of claim 4, wherein notof the barbs align radially or axially.
 11. The soft tissue anchor ofclaim 4, wherein the barbs are cut into and pealed back from an outersurface of the elongated body.
 12. The soft tissue anchor of claim 4,wherein the axially extending passage is a through passage extendingbetween the proximal and distal ends of the elongated body.
 13. The softtissue anchor of claim 4 having a maximum outside diameter, notincluding the barbs of less than about 4 mm.
 14. The soft tissue anchorof claim 4 having a maximum outside diameter, not including the barbs ofbetween about 2mm and about 4 mm.
 15. The soft tissue anchor of claim 4including a slot extending distally from the proximal end of the anchoralong a cross-sectional radius of the anchor, the slot being sized andshaped for receiving a sling end.
 16. The soft tissue anchor of claim 4having a loop extending from the proximal end of the anchor, the loopbeing sized and shaped for slidably receiving a sling.
 17. The softtissue anchor of claim 16, wherein the loop includes radially inwardlyoriented projections sized and shaped to allow a sling to pass in afirst direction and for inhibiting the sling from passing back in anopposite direction.
 18. The soft tissue anchor of claim 4 includingfirst and second radially oriented elongaged through apertures in a sidewall of the anchor, the apertures being in communication with thechamber, being separated by a cross member, and being sized forreceiving a sling.
 19. The soft tissue anchor of claim 18 includingprojections extending into at least one of the first and secondapertures sized, shaped and oriented to pass a sling in a firstdirection and to resist passing back in an opposite direction.
 20. Thesoft tissue anchor of claim 4 including a bar located within the chamberof the anchor and extending across the chamber between first and secondlocations on an internal wall defining the chamber, the bar being sizedand shaped for passing a sling around it.
 21. The soft tissue anchor ofclaim 20, wherein the bar includes projections sized, shaped andoriented for passing a sling around it in a first direction and forinhibiting the sling from passing back in an opposite direction.
 22. Thesoft tissue anchor of claim 20, wherein the internal wall includesprojections sized, shaped and oriented for passing a sling around thebar in a first direction and for inhibiting the sling from passing backin an opposite direction.
 23. The soft tissue anchor of claim 4, whereinat least two of the barbs are smaller as compared to others of thebarbs, are located near the distal end of the anchor, and are sized andshaped for interlocking with mating structures on an internal wall neara proximal end of another anchor.
 24. The soft tissue anchor of claim 24comprising indentations near the proximal end of the anchor on aninternal wall defining the chamber, the indentations be sized, shapedand oriented for interlocking with mating projections on a distal end ofthe other anchor.
 25. The soft tissue anchor of claim 24, wherein theindentations are through apertures extending between the internal wallof the chamber and an external surface of the anchor.
 26. A soft tissueanchoring system comprising, a plurality of anchors, each of the anchorsincluding proximal and distal ends, internal and external surfaces, andan internal chamber defined by the internal surface and extending fromthe proximal end of the anchor at least part way to the distal end, eachof the anchors also including one or more radial projections located onthe external surface near a distal end of the anchor, and indentationslocated on the internal surface near the proximal end of the anchor, theradial projections of each of the plurality of anchors being sized,shaped and oriented to matingly snap fit with the indentations of othersof the plurality of anchors to enable stacking of the plurality ofanchors to form anchors of increased length.
 27. The soft tissue anchorsystem of claim 26, wherein the indentations for through aperturesextending between the internal and external surfaces if the anchors. 28.A soft tissue anchoring system comprising, an anchor including proximaland distal ends, internal and external surfaces, an internal chamberdefined by the internal surface and extending from the proximal end ofthe anchor at least part way to the distal end of the anchor, and a loopextending from the proximal end of the anchor, the loop being sized andshaped for slidably receiving a sling, and means separate from theanchor for prohibiting the anchor from sliding off the sling.
 29. A softtissue anchor system comprising, an anchor including proximal and distalends, internal and external surfaces, an internal chamber defined by theinternal surface and extending from the proximal end of the anchor atleast part way to the distal end of the anchor, and a bar located withinthe chamber of the anchor and extending across the chamber between thefirst and second locations on the internal wall, the bar being sized andshaped for passing a sling around it, and means separate from the anchorfor prohibiting the anchor from sliding off the sling.
 30. A slingassembly comprising, an implantable sling having first and second endsand a aperture located near the first end, at least one tissue anchorhaving proximal and distal ends, a passage extending axially in a distaldirection from the proximal end of the tissue anchor at least part wayto the distal end of the tissue anchor, and an aperture in a side wall,and a filament having first and second ends, the first end of thefilament threading through the aperture in the side wall of the tissueanchor, the second end of the filament threading through the aperture ina sling end, the first and second ends of the filament being securedtogether by a slidable mechanism.
 31. The sling assembly of claim 30,wherein the slidable mechanism is a one-way slip knot.
 32. A slingassembly comprising, an implantable sling having first and second endsand first and second apertures located near the first end, a tissueanchor having proximal and distal ends with the proximal end attached tothe first end of the implantable sling, and a filament having first andsecond ends, the first end passing through the first aperture in thesling and the second end passing through the second aperture in thesling, the first end of the filament also being interwoven with thesling along a portion of a first long edge of the sling, and the secondend of the filament also being interwoven with the sling along a portionof a second long edge of the sling, the first and second filament endsbeing drawable to accordion the portion of the sling with which theyinterweave to shorten a length of the sling.
 33. A sling assemblycomprising, a first sling assembly section including a first slingsection having a first end attached to a first tissue anchor and asecond free end, a second sling assembly section including a secondsling section having a first end attached to a second tissue anchor anda second free end, and the first free ends of the first and second slingassembly sections being attachable together to form a custom lengthsling assembly.
 34. The sling assembly of claim 33 comprising a clip forclipping the first free ends of the first and second sling assemblysections together.
 35. The sling assembly of claim 33 including anaperture near the first free end of the first sling assembly section,and projections along a portion of the second sling section, theaperture begin sized and shaped for passing the second tissue anchor andthe second sling in a first direction and for engaging with theprojections to resist passing at least the portion of the second slingsection back in an opposite direction.
 36. A sling assembly comprising,an anchor including proximal and distal ends, and a loop extending fromthe proximal end of the anchor, an implantable supportive sling, anelongated element having radial projections extending from an end of thesupportive sling, and the loop and the elongated element being sized andshaped for allowing the elongated element to pass through the loop in afirst direction but inhibit the elongated element from passing back inan opposite direction to attach the anchor to the implantable supportivesling.
 37. A sling assembly comprising, an anchor including proximal anddistal ends, internal and external sides, an internal chamber defined bythe internal side and extending from the proximal end of the anchor atleast part way to the distal end of the anchor, and an implantablesupportive sling attached to a location on the external side of theanchor about midway between the proximal and distal ends of the anchor.38. The sling assembly of claim 37, wherein the sling is attacheddirectly to the anchor.
 39. The sling assembly of claim 37, wherein thesling is attached indirectly to the anchor.
 40. The sling assembly ofclaim 39, wherein the indirect attachment is via a suture.
 41. A slingdelivery device comprising, a handle, and a shaft extending distallyfrom a distal end of the handle, the shaft having first and secondsections, the first section having a greater outside diameter than thesecond section to form a radially extending shoulder between the firstand second sections, the second section having a length of at leastabout 3 cm.
 42. The delivery device of claim 41, wherein the secondsection has a length of at least about 4 cm.
 43. The delivery device ofclaim 41, wherein the second section has an outside diameter of betweenabout 0.03 inch and about 0.05 inch.
 44. The delivery device of claim41, wherein the first section has an outside diameter of between about0.07 inch and about 0.1 inch.
 45. A delivery device comprising, ahandle, a shaft extending distally from the handle, and a pusherassembly including a cannula slidably interfitted over the shaft and auser actuator attached to the cannula for enabling a user to slide thecannula back and forth over the shaft, wherein with the cannula fullyretracted, the shaft has an exposed distal portion having a length of atleast about 3 cm.
 46. The delivery device of claim 45, wherein theexposed distal portion has a length of at least about 4 cm.
 47. Adelivery device comprising, a handle, a cannula extending distally fromthe handle, and a shaft slidably interfitted within the cannula andmechanically coupled to a slider on the handle for sliding the shaftback and forth within the cannula, wherein with the shaft in a fullyextended position, the shaft has an exposed distal portion having alength of at least about 3 cm.
 48. The delivery device of claim 42,wherein the exposed distal portion has a length of at least about 4 cm.49. A delivery device comprising, a dilator having an elongated bodywith apertures at proximal and distal ends and a through lumen extendingaxially therebetween, an elongated guide member longer than the dilatorand sized and shaped for slidably interfitting and axially passingthrough the through lumen of the dilator, and a pusher having a handlewith distal and proximal ends and a through lumen extending axiallythere between, and a cannula extending axially from the distal end ofthe handle and including a through lumen, the through lumen of thehandle being axially aligned with the through lumen of the cannula, andboth being sized for slidably interfitting over the elongated guidemember to advance an anchor distally along the guide member.
 50. Amethod for implanting a tissue anchor attached to a supportive sling toan anatomical site within the body of a patient, the method comprising,inserting an elongated dilator having proximal and distal ends and athrough lumen extending there between distal end first into a body of apatient via an incision in a vaginal wall, advancing the dilator untilthe distal end of the dilator is near the anatomical site, advancing anelongated guide member through the lumen of the dilator at least until adistal tip of the elongated guide member is exposed through the distalend of the dilator, sliding the dilator proximally over the guide memberto remove the dilator from the body of the patient, advancing a hollowanchor attached to a sling proximally over the guide member until theanchor is at the anatomical site, and removing the guide member to leavethe anchor implanted within the body of the patient at the anatomicalsite.
 51. The method of claim 49, wherein the anatomical site is withinan obturator membrane of the patient.
 52. The method of claim 49,wherein the anatomical site is through the obturator membrane into theobturator formamen of the patient.
 53. The method of claim 50, whereinthe anatomical site is between about 1 cm and about 2.5 cm into theobturator foramen, as measured from an obturator foramen side of theobturator membrane.